RN Care Coordinator
Location: Clearwater, FL
The Care Coordinator is a Registered Nurse who provides care coordination, medical and disease education, and outreach services to Medicaid members in the government programs.
Essential Duties and Responsibilities:
- Serves as a member advocate providing support, triage and resolution of member issues
- Serves as a facilitator to providers for resolution or provider concerns, complaints and grievances.
- Maintains and ensures the confidentiality of all information collected during the review process
- Participates in developmental and quality training programs
- Identifies individual care needs based on assessment outcomes
- Communicates program parameters with providers and members
- Establishes care needs and goals based on individual care requirements
- Establishes and updates care plans based on departmental policies and procedures
- Communicates with physicians, patients and family members regarding care plans, goals and expected outcomes
- Monitors clinical and functional status based on goals and outcomes
- Maintains appropriate level of experience and/or education to oversee care for specialty populations
- Instructs patients telephonically in Disease Management Programs
- Analyzes medical and pharmaceutical claims data
- 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
Supervisory Responsibilities: None
- Strong organizational and interpersonal skills
- Excellent written and verbal communication skills
- Detail oriented
- Ability to multi-task and work independently
- Excellent customer service skills
- A minimum of three (3) years of Case Management or Disease Management experience is strongly preferred
- Demonstrated knowledge of utilization management principles
Education and/or Experience:
- A Bachelor’s degree in a health related field is strongly preferred.
- A minimum of two (2) years critical care experience or five (5) years of general nursing experience.
Certificates, Licenses, Registrations:
- Certified Case Management (CCM) Certification is required within four (4) years of employment. Other certifications recognized by URAC are also acceptable.
- Current RN licensure in Florida and other states where business is conducted
Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook. Ability to type care coordination documentation directly into the system.
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 vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.
To apply, please forward resume to firstname.lastname@example.org
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