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*Case Manager - RN Office Setting (Tampa, FL)-1400006

IBM Type Full time Posted 4/23/2014
Salary - n/a - Starts - n/a -
FL - Florida (All) - Tampa Referral - n/a -    
*Case Manager - RN Office Setting (Tampa, FL)-1400006
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
 Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the Supervisor / Manager of Case Management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the Member.

Essential Functions:
  • In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establishes case management objectives.
  • Manages 60 to 80 active cases based on case intensity and acuity. Specialty Case Manager case loads may vary.
  • Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
  • Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
  • Maintains accurate records of case management activities in the EMMA System using clinical guidelines.
  • Coordinates community resources with emphasis on medical, behavioral and social services. Applies case management standards and 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.
  • Schedules or facilitates scheduling appointments and follow-up services
  • Requests consultation and diagnostic reports from network specialists.
  • Contacts members to remind them about upcoming appointments and/or missed appointments.
  • Participates in monthly chart audits.
  • Performs special projects as assigned.
Additional Responsibilities:
  • Case load may differ by state and/or location based on contract requirements, membership, plan and/or operational best practice.
  • Some states and/or locations may require nurses to occasionally travel to facility or inpatient bedside to conduct assessments or face to face visits.
Qualifications
 Candidate Education:
  • Required          A High School or GED
  • Preferred          A Bachelor's Degree in nursing or related field
Candidate Experience:
  • Required           2+ years of experience in a clinical acute care position(s), preferably in home health, physicians office or public health
  • Required           1+ year of experience in current case management experience
Candidate Skills:
  • Intermediate       Ability to drive multiple projects a plus
  • Intermediate       Ability to multi-task
  • Intermediate       Ability to work in a fast paced environment with changing priorities
  • Intermediate       Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
  • Intermediate       Demonstrated time management and priority setting skills
  • Intermediate       Demonstrated interpersonal/verbal communication skills
  • Intermediate       Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans
  • Intermediate       Demonstrated negotiation skills
  • Intermediate       Ability to effectively present information and respond to questions from families, members, and providers
  •       Ability to effectively present information and respond to questions from peers and management
  • Intermediate       Ability to implement process improvements
Licenses and Certifications:
  • Required          Licensed Registered Nurse (RN)
  • Preferred          Certified Case Manager (CCM)
Technical Skills:
  • Required          Intermediate       Microsoft Excel Intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express
  • Required          Intermediate       Microsoft Word
  • Required          Intermediate       Healthcare Management Systems (Generic)
  • Required          Intermediate       Microsoft Outlook
Languages:
  • Preferred          Other Bilingual skills

Primary Location

 FL-Tampa

Is a relocation package available?
 No