Complex Case Manager RN

Company: DFW Texas Staffing
Location: Deltona
Posted on: February 3, 2020

Job Description:

Required skills & experience (the 7 must haves to be considered): 1. Active, unrestricted RN (BSN preferred) license in Florida (Willingness to obtain additional state licenses as needed) 2. Utilization knowledge on Part A, Part B and part D Medicare. 3. Medicare/ Medicare Advantage experience is strongly preferred, but if no Medicare Advantage experience then candidate needs to have Complex/Case Management experience. 4 Knowledges of HEDIS 5. Two years case management at a managed care plan or provider organization and knowledge of the evidence based guidelines for the main chronic conditions-HTN, CAD, Heart Failure, Diabetes, CKD and COPD. 6. Ability to understand CMS guidelines 7. Understanding of the basic principles for OSHA, CLIA, HIPAA and AHCA. What you need to know: Adaptability is key. Oscar moves quickly and things change. Candidate must be able to adapt and pivot. RN must be Self-motivated-this role is remote and this role requires RN to be able to keep themselves motivated and on track with daily responsibilities. The assigned Registered Nurse (RN) will operate within the companys Clinical Care Delivery department providing onsite and telephonic care management services to Medicare Advantage individuals identified as high risk members. Serve as the primary point-of-contact for a selected group of Medicare Advantage members and their families. Will travel between the office, member's homes and acute and subacute facilities. Will participate in twice weekly meetings with Medical Director to review members progress, update the plan of care as needed. Works in collaboration and continuous partnership with chronically ill or "high-risk" patients and their family/caregiver(s) in a team approach to: -Reduce emergency room utilization and hospital readmissions. -Promote timely access to appropriate care. -Increase utilization of preventative care. Initiates onsite hospital visits/rounds as needed to assess patient progress and meet with appropriate members of the patient care team.

Keywords: DFW Texas Staffing, Deltona , Complex Case Manager RN, Executive , Deltona, Florida