RN Case Manager

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🔥 3 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $71.2k - $89k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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GuideWell Source

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

📋 Description

• Engage Members telephonically, using digital engagement tools and/or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education. Facilitate access to care and resources to meet the member’s health care needs. Provide education and tools to promote self-management. • Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services, behavioral health and / or community resources. • Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed. • Close gaps in care • Conduct Medication Reconciliation • Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals. • Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses. • Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.

🎯 Requirements

• 2+ years related work experience • Related Bachelor’s degree or additional related equivalent work experience • Registered Nurse - State Licensure and/or Compact State Licensure • Experience with influencing and motivating individuals to change health behaviors • Knowledge and/or experience with population health • Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management • Experience working 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 for all lines of business • Non-traditional working hours to meet the member's availability • Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone. Basic technology skills with digital tools and apps. • Must have valid driver's license and reliable transportation • Occasional travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays

🏖️ Benefits

• Medical, dental, vision, life and global travel health insurance • Income protection benefits: life insurance, short- and long-term disability programs • Leave programs to support personal circumstances • Retirement Savings Plan including employer match • Paid time off, volunteer time off, 10 holidays and 2 well-being days • Additional voluntary benefits available; and a comprehensive wellness program