RN - Outpatient Case Manager - FHHS
Job ID: 24370
The Care Manager reports to the Director of Medical Management/Precertification of FHHS. The function of the care manager is to coordinate care, educate members, and provide interventions within the scope of case management practice that have direct influence on clinical and financial outcomes. It is a dynamic and systemic collaborative approach to providing and coordinating health care services to a defined population. Responsibility includes identification of high-risk patients, assessment of healthcare needs, collaboration and coordination with health care providers, development of medical treatment plans, quality management activities, coordination and support of inpatient and outpatient utilization management activities. Participates in the process to identify and facilitate options and services for meeting individuals' health care needs, while decreasing fragmentation and duplication of care and enhancing quality and cost-effective clinical outcomes. Shared accountability for cost savings and meeting department utilization metric goals. Actively participates in outstanding customer service and accept responsibility in maintaining relationships that are equally respectful to all.
Knowledge and Skills Required:
Comprehensive knowledge and understanding of chronic and acute disease conditions, management, and treatment. Ability to interact effectively with physicians and other health care professionals. Excellent written and verbal communication skills in English. Computer knowledge/skills and proficiency in applications such as Microsoft Outlook, Word, and Excel is preferred.
Education and Experience Required:
Graduate school of nursing required. Bachelor in Science of Nursing (BSN) or advanced degree preferred. Experience in clinical nursing with a minimum of 3 years experience in the following job areas is preferred: Case management, quality assurance, utilization management, insurance/managed care industry, hospice/home health care, and geriatric care.
Licensure, Certification, or Registration Required:
Current registration with Florida State Board of Nursing. Nurse licensure in good standing with the state of Florida. Certified Case Manager (CCM) preferred.
