Case Manager, RN

This is a fully remote position, open to applicants in Florida.

📋 Description

• Connect with Members through phone calls, digital engagement tools, and face-to-face interactions at Florida Blue Retail Centers, hospitals, and other locations, emphasizing health coaching and member education. Assist in accessing care and resources to address members' health care needs. Offer education and tools that encourage self-management.

• Strategically plan, implement, coordinate, and oversee Case Management activities, which may encompass acute and non-acute services, outpatient services, behavioral health, and community resources.

• Facilitate care for high-risk members throughout their health care journey, including care transitions, coordination of community and social services, and collaboration with other value-based organizations and providers as necessary.

• Address and close gaps in care.

• Perform Medication Reconciliation.

• Collaborate with Members, their Physicians, Plan Medical Directors, Managers, local, regional, and specialty team members, as well as other functional areas to help members achieve their health care objectives.

• Advocate for healthy lifestyles, promote a strong patient-physician relationship, and encourage behavioral and lifestyle changes to enhance the quality of life for individuals with chronic conditions or significant illnesses.

• Assist Members and their physicians in navigating the health continuum, educating them about benefits, identifying candidates for Care Programs, and providing information about network access and services.

⛳️ Requirements

• A minimum of 2 years of relevant work experience in building relationships with members, providers, and employers through phone and in-person interactions.

• A related Bachelor's degree or equivalent work experience.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure.

• Proven experience in influencing and motivating individuals to alter health behaviors.

• Knowledge and/or experience in population health.

• Experience in two or more of the following areas: home health care, utilization review, discharge planning, and disease/case management.

• Familiarity with Managed Care products, benefits, and services.

• Experience in planning, implementing, coordinating, and monitoring activities that focus on acute and non-acute services, outpatient services, and/or community resources across all lines of business.

• Willingness to work non-traditional hours to accommodate members' availability.

• Basic to intermediate proficiency in MS Word, Excel, tablets, and/or smartphones.

• Basic technical skills with digital tools and applications.

• Ability to travel up to 30% (subject to change) for on-site meetings, events, or manager requests involving members, providers, or employers.

• A valid driver's license and reliable transportation are required.

🏝️ Benefits

• Medical, dental, vision, life, and global travel health insurance.

• Income protection benefits, including life insurance and short- and long-term disability programs.

• Leave programs available to support personal circumstances.

• Retirement Savings Plan with employer matching contributions.

• Paid time off, volunteer time off, 10 holidays, and 2 well-being days.

• Additional voluntary benefits are also available.

• A comprehensive wellness program.