Chronic Care Manager (RN) Onsite

PEOple Premier, Inc.; Clearwater (FL); Remote; USD 65,000 - 85,000; Full time

Job summary

Premier Family of Companies is seeking a Chronic Care Case Manager (RN) to provide telephonic case management, education, and outreach to Medicare members in Florida. Requires active Florida RN licensure; remote work arrangement with strict HIPAA compliance.

Responsibilities include coordinating care, educating members, and collaborating with the Care Advocate Team to ensure service delivery and accurate documentation. Strong communication and organizational skills are essential.

Qualifications

• Minimum of three years of recent adult clinical experience.
• Bachelor’s degree in nursing strongly preferred.
• Medicare program experience preferred; bilingual Spanish preferred.

Responsibilities

• Fulfills requirements to complete monthly contacts with enrolled members and keep system records accurate.
• Educates members to achieve health maintenance goals and arranges needed education services.
• Collaborates with Care Advocate Team to ensure all services and documentation are addressed.
• Acts as a member advocate, addressing complaints and escalating as needed.
• Manages PHI per HIPAA and related laws.

Skills

Organizational skills

Interpersonal skills

Motivational skills

Written and verbal communication

Education

Bachelor's degree in nursing

Tools

Microsoft Office

EHR/EMR systems

Job description

• Location 6021 142nd Avenue North,Clearwater, FL, 33760,United States
• Employee Type Exempt

Contact information

• Name Sally Jackson

Description

Position Summary

The Chronic Care Case Manager is a Registered Nurse who provides case management, education and outreach services telephonically to Medicare members in the Chronic Case Management Program. This position requires licensure as a Registered Nurse in the State of Florida, compact licensure required. This is a remote position.

Essential Duties and Responsibilities

• Fulfills requirements established by Community Health Solutions to complete monthly contacts with enrolled members. Ensuring the information contained in the system of record is accurate and complete.
• Provides members with education required to achieve optimal health maintenance and arranges appropriate education services, if necessary.
• Collaborate with the Care Advocate Team to ensure all required services, communications, documentation, and ancillary needs are addressed. Maintains availability to members and providers to coordinate any required services.
• Serve as a member advocate. Addresses and identifies complaints, grievances, or concerns and escalates to the appropriate stakeholder(s), when necessary.
• Identifies availability of advanced directives, needs for ancillary services, specialty services and community services.
• Upon member ineligibility or other circumstance in which disenrollment from the program becomes necessary, complete all needed activities to ensure continuation of care and communicate with all stakeholders to ensure an uninterrupted transition of care.
• Serve as a mandated reporter.
• Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).

Supervisory Responsibilities

• LPN oversight
• Strong organizational, interpersonal and motivational skills
• Excellent written and verbal communication skills
• Detail oriented
• High level of reasoning and analytical skills
• Ability to multi-task and work independently

Qualifications:

• A Minimum of three (3) years of recent adult clinical is required.
• A bachelor’s degree in nursing is strongly preferred.
• Previous work experience with a Medicare program is preferred.
• Bilingual (Spanish) is preferred.

Certificates, Licenses, Registrations:

• Certified Case Management (CCM) Certification is preferred.
• Current RN licensure in states where business is conducted.

Computer Skills:

Demonstrated computer proficiency with Microsoft Office, electronic health record (EHR/EMR) systems, Medicaid documentation and care management platforms, and the ability to efficiently navigate multiple electronic systems while maintaining accurate, timely, and compliant clinical documentation in accordance with state and regulatory requirements.

Environmental Factors/Physical Demands

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone.May be subject to repetitive motion such as typing, data entry and sustained visual attention to monitors. The position requires prolonged periods of sitting, keyboarding, and viewing computer monitors. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

HIPAA and Data Privacy Obligations

Due to the nature of this position and its involvement with the Medicare members, you will have access to Protected Health Information (PHI) governed by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable federal and state privacy laws.

This role has direct access to Protected Health Information (PHI). The following rules are non-negotiable:

• Absolute confidentiality: Employees must not disclose PHI to unauthorized individuals under any circumstances.
• Secure environment: A private, locked workspace must be maintained to prevent exposure of PHI to family members, visitors, or others.
• Company-approved technology only: All work must be performed on secure, company-issued devices using encrypted connections (VPN required).

You will be required to complete HIPAA training upon hire and annually thereafter. Any breach of confidentiality or unauthorized disclosure of patient information may result in disciplinary action up to and including termination and may carry legal consequences under state or federal law.

Other Responsibilities

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.

• Adheres to the policies and procedures of Community Health Solutions
• Maintains strict confidentiality of client, company, and personnel information
• Demonstrates a strong commitment to the mission and values of the organization Adheres to company attendance standards
• Performs other duties as assigned
• Completes all annual training assigned by the deadline for completion
• Will demonstrate successful completion and compliance with all policies and procedures, to be assessed during quarterly performance reviews
• Criminal background and OIG must remain in good standing.
• Will abide by the Ethical Code of Conduct set forth by the company, to be reviewed and signed yearly.

Drug Free Workplace

Premier Family of Companies and its affiliates is committed to providing a safe, healthy, and productive work environment for all employees. To achieve this, CHS maintains a smoke-free and drug-free workplace. Candidates who receive a conditional offer must complete a pre-employment drug screen. Random and post-incident testing may also be required .

Confidentiality

You agree to maintain the confidentiality of all proprietary and non-public information obtained during your employment. This includes, but is not limited to, company records, financial data, client and vendor information, business strategies, and any other information not generally known outside the Company. You may not use or disclose such information during or after your employment, except as required in the performance of your duties. All company property and materials must be returned upon separation of employment.

At-Will Employment

Please note that employment in Florida or South Carolina is at-will, and either you or CHS may terminate the employment relationship at any time, with or without cause or notice. Nothing in this letter creates a contract for continued employment.

Reports to: Director of Case Management

SBU: Community Health Solutions of America

Additional Information

• SBU Name CHS - Chronic Care Mgmt
• Type of Position Brand New to Co.
• Professional License Registered Nurse
• Employment Type Onsite 5 Days
• Employment Status Full Time - Exempt (Salary)