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*Disease Mgmt Nurse - RN - Office Setting (Tampa, FL)-1402009

IBM Type Full time Posted 4/23/2014
Salary - n/a - Starts - n/a -
FL - Florida (All) - Tampa Referral - n/a -    
*Disease Mgmt Nurse - RN - Office Setting (Tampa, FL)-1402009
About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled, as well as prescription drug plans. The company serves approximately 3.3 million members nationwide as of January 1, 2014. The company employs more than 5,100 nationwide. For more information about WellCare, please visit the company's website at www.wellcare.com. A Fortune 500 company traded on the New York Stock Exchange (symbol: WCG).

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.
 
Description
 
The Disease Management Nurse performs telephonic contact with members who have been pre-identified as having chronic disease states. Completes clinical assessments on each member to determine the educational health needs based on their disease process, and to monitor the level of adherence.  Provides self-management support including care integration for the members enrolled into the disease management program.  Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes.  Assesses, plans, implements, coordinates, monitors and evaluates care plans, services and outcomes to maximize the health of members.       
 
Essential Functions
  • Provides telephonic member assessment as the result of inbound and outbound member phone calls.
  • Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services.  Assesses short-term and long-term needs and establishes disease management objectives.
  • Educates and assists members in understanding their disease process in an effort to increase self-management maximize optimal health
  • Emphasizes the importance of health education and teaches member behavior modification techniques
  • Utilizes evidenced based guidelines to educate members on their specific disease process
  • Identifies members educational needs and mail appropriate educational material to each member
  • Monitor members per results of the clinical assessment on a continual basis
  • Promotes and encourages members regarding adherence to their care plan and treatment as set by the caregiver Provide referrals as appropriate.
  • Communicates with providers regarding member needs.
  • Collaborates with Case Managers on cases to review care plans and make changes if necessary.
  • Acts as liaison and member advocate between the member and their family, physician and facilities/agencies. 
  • Manages 400 active cases based on case intensity and acuity.
  • Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status,  Assesses options for care including use of benefits and community resources to update the care plan as needed.
  • Maintains accurate record of disease management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines.
  • Maintains HIPAA standards and confidentiality of protected health information.  Reports critical incidents and information regarding quality of care issues. Maintains HIPAA standards and confidentiality of protected health information.  Reports critical incidents and information regarding quality of care issues.
  • Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
  • Coordinates community resources with emphasis on the development of natural support system.  Coordinates benefits, regulations, laws and public entitlement programs for members.
  • Performs other duties as assigned.
Qualifications
 
Education/Experience:
  • Registered Licensed Nurse (RN).  A Bachelor's Degree in Health Administration or BSN preferred.
  • 2-4 years clinical acute care experience in varied health care settings with an expertise in cardiovascular disease, diabetes, asthma, pediatrics etc. 
  • At least 1-3 years disease management experience. 
  • Managed care experience preferred but not required.
Licenses/Certifications: 
  • Current state Registered Licensed Nurse (RN).
Special Skills (e.g. 2nd language): 
  • Bilingual skills a plus
  • Assists in evaluating process improvements
  • Ability to work independently, handle multiple assignments and prioritize workload 
  • Demonstrates high level time management and priority setting
  • Communicates effectively in person and by phone
  • Advanced ability as a licensed professional to communicate on any level required to meet the demands of the position.
  • Ability to create, review and interpret treatment plans
  • Demonstrates negotiation skills
  • Demonstrates effective communication methods and skills, using lines of authority appropriately
Computer Skills:
  •  Intermediate knowledge and skill of MS Office including Excel, Word and Outlook Express

Primary Location

 FL-Tampa

Is a relocation package available?
 No