Readmission Prevention Case Manager RN - West Palm Beach /Remote

Florida Blue; Orlando (FL); Remote; USD 69,000 - 87,000; Full time

Job summary

A leading health insurer seeks a Readmission Prevention Case Manager RN to support patients post-discharge by conducting assessments, coordinating care plans, and ensuring appropriate follow-ups. This full-time position emphasizes strong clinical skills and effective communication, with a focus on reducing readmission rates through proactive care management.

Benefits

Medical, dental, vision insurance

Paid time off and holidays

Retirement Savings Plan with employer match

Qualifications

• 2+ years of clinical experience in acute or home care settings.
• Current Florida RN licensure required.
• Bilingual English/Spanish is a plus.

Responsibilities

• Conduct assessments within 2 business days post-discharge.
• Facilitate follow-up visits and provide ongoing telephonic support for at least 30 days.
• Coordinate necessary community resources to overcome care barriers.

Skills

Assessment Skills

Care Coordination

Medication Reconciliation

Communication

Education

Associate’s Degree in Nursing

Tools

Microsoft Office Suite

Job description

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Join to apply for the Readmission Prevention Case Manager RN - West Palm Beach /Remote role at Florida Blue

• Meet with members, (and/or their caregivers) who are at high risk for readmission, post discharge, in person preferrably, within 2 business days of discharge.
• Perform an assessment of members current health status, including potential knowledge deficits, environment, care giver(s) and others supports, creating a care plan identifying problems, goals and interventions, based on member's responses, conditions, needs and priorities, as appropriate.
• Conduct Comprehensive Medication Reconciliation process, including education, identification of potential medication concerns, document and address any possible issues with the ordering physician, pharmacy, etc. and provide CMR report to PCP
• Validate the initiation of planned care and services, reinforce understanding of discharge instructions utilizing teach back methods, answer questions as appropriate and address concerns.
• Coordinate/assign necessary interventions including any available community resources, enhanced benefits or flex benefit to overcome potential barriers to care, e.g. meals, transportation, etc.
• Facilitate appropriate practitioner office follow-up visit within 7-14 days of discharge. Follow-up with member and practitioner to confirm appointment was kept.
• Provide continuing telephonic support/follow up for at least 30 days post facility discharge.
  
  

Job Description

What are the Key Responsibilities:

• Meet with members, (and/or their caregivers) who are at high risk for readmission, post discharge, in person preferrably, within 2 business days of discharge.
• Perform an assessment of members current health status, including potential knowledge deficits, environment, care giver(s) and others supports, creating a care plan identifying problems, goals and interventions, based on member's responses, conditions, needs and priorities, as appropriate.
• Conduct Comprehensive Medication Reconciliation process, including education, identification of potential medication concerns, document and address any possible issues with the ordering physician, pharmacy, etc. and provide CMR report to PCP
• Validate the initiation of planned care and services, reinforce understanding of discharge instructions utilizing teach back methods, answer questions as appropriate and address concerns.
• Coordinate/assign necessary interventions including any available community resources, enhanced benefits or flex benefit to overcome potential barriers to care, e.g. meals, transportation, etc.
• Facilitate appropriate practitioner office follow-up visit within 7-14 days of discharge. Follow-up with member and practitioner to confirm appointment was kept.
• Provide continuing telephonic support/follow up for at least 30 days post facility discharge.
  
  

What Is Required

• 2+ years’ experience recent clinical acute, home care and/or case management experience
• Current Florida RN - Registered Nurse Licensure And/or Compact State Licensure Without Restriction
• Hands-on experience with Microsoft suite of products, including Word, Outlook, PowerPoint, etc., as well as navigating through multiple systems such as electronic medical records
• Ability to drive your own vehicle to and from home assessment visits, and/or in clinical settings, within Palm Beach County (West Palm Beach and surrounding areas), FL approximately 20-40% of work time
• Current and valid state driver's license
• Associate’s degree in nursing
  
  

What Is Preferred

• CCM - Certified Case Manager Certification
• Home care Experience
• Bilingual English/Spanish
• Bachelor’s degree in nursing
  
  

General Physical Demands

Medium work: Exerting up to 50 pounds of force occasionally and/or up to 20 pounds of force frequently to move objects.

Physical/Environmental Activities

Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Frequently May be exposed to outdoor weather conditions of cold, heat, wet, and humidity. Occasionally Must be able to ascend and descend ladders, stairs, or other equipment.

What We Offer

As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, Short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan includes employer contribution and employer match;
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available; and a comprehensive wellness program
  
  

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Typical Annualized Hiring Range: $69,400 - $86,800, within an annualized full salary range of $69,400 - $112,800

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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