RN Care Manager (Hybrid)

5297 W Copans Rd, Margate, FL 33063, USA

Req #525

Monday, June 3, 2024

Care Solutions' goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

Primary Responsibilities:

Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs

Develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the member’s care.

Initiates utilization review for preauthorization and post service reviews

Utilizes knowledge of community resources and the member’s benefit structure

Interacts with providers and facilities in a professional, respectful manner

Recognizes quality of care issues and escalates the issues appropriately

Assists members with the coordination of services from various settings as appropriate

appropriate

Complies with all CCSs standards for documentation

Participates in case rounds

Participates in on call coverage

Participates in other meetings as requested

Participates in quality improvement initiatives

Other duties as assigned

Required:

Strong written and verbal communication skills

Preferred:

Bachelor of Science in Nursing

CCM certification

Knowledge of Milliman or InterQual criteria

Experience providing care in the home setting

Experience working within a managed care environment

We offer:

Hybrid schedule (for employees who qualify)Care Solutions is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.

Other details

Pay Type Salary Apply Now

5297 W Copans Rd, Margate, FL 33063, USA