RN Case Manager

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

📋 Description

• Connect with Members through phone calls, digital engagement tools, and in-person interactions at Florida Blue Retail Centers, hospitals, and other locations, focusing on health coaching and member education. Assist in facilitating access to care and resources to address the member’s health care needs while providing education and tools to encourage self-management.

• Design, execute, coordinate, and oversee Case Management activities that may encompass acute and non-acute services, outpatient services, behavioral health, and/or community resources.

• Support care for high-risk members throughout the entire health care journey, including managing care transitions, coordinating community and social services, and liaising with other value-based organizations and providers as necessary.

• Address gaps in care.

• Perform Medication Reconciliation.

• Work collaboratively with Members, their Physicians, Plan Medical Directors, Managers, and Local, Regional, and Specialty team members, as well as other functional areas, to help members achieve their health care goals.

• Encourage healthy lifestyles, enhance the patient-physician relationship, and promote behavior and lifestyle changes for improved quality of life for individuals with chronic conditions, expensive, and/or catastrophic illnesses.

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

⛳️ Requirements

• Minimum of 2 years of relevant work experience.

• A related Bachelor’s degree or equivalent additional work experience.

• Current Registered Nurse State Licensure and/or Compact State Licensure.

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

• Knowledge of and/or experience in population health.

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

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

• Experience in planning, implementing, coordinating, and monitoring activities that emphasize 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 skills in MS Word, Excel, and experience with tablets and/or smartphones. Fundamental technology skills with digital tools and applications.

• Must possess a valid driver's license and reliable transportation.

• Occasional travel up to 30% (subject to change) for on-site meetings with members, providers, or employers, events, or manager requests, including potential overnight stays.

🏝️ Benefits

• Comprehensive medical, dental, vision, life, and global travel health insurance.

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

• Leave programs designed 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 and a comprehensive wellness program available.