Position Title: Managed Care Coordinator-RN Clinician
Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
*Must be a resident of Florida*
The Managed Care Coordinator - RN Clinician is responsible for overall management of members case within the scope of licensure. Provides supervision and direction to non-RN clinicians participating in the members case in accordance with applicable state law and contract. Develops, monitors, evaluates, and revises the members care plan to meet the members needs, with the goal of optimizing member health care across the care continuum.
How you'll make a difference
- Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of members needs, including physical health, behavioral health, social services and long term services and supports.
- Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.
- Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
- Obtains a thorough and accurate member history to develop an individual care plan.
- Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.
The RN has overall responsibility to develop the care plan for services for the member and ensures the members access to those services.
- May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.
- Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans.
- May also assist in problem solving with providers, claims or service issues. Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the members care plan to meet the members needs, and reviewing and providing input on the non-RN clinicians' performance on a regular basis.
Minimum Requirements
- Requires a HS diploma or equivalent and minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.
- Current, active valid and unrestricted RN license in applicable state(s) required.
Preferred skills, qualifications and experience
- HIV experience highly preferred
- Bilingual Spanish/English or Creole/English desired.
- May require state-specified certification based on state law and/or contract.
- Travels to worksite and other locations as necessary.
Job Level: Non-Management Non-Exempt
Workshift: 1st Shift (United States of America)
Job Family: MED > Licensed Nurse