CCM (RN) Hybrid/Remote Case Manager -Florida

Position Summary The Case Manager is a Registered Nurse who provides case management, education and outreach services telephonically to Medicare members in the Chronic Case Management Program.

This position requires licensure as a Registered Nurse in the State of Florida, compact licensure required.

This is a hybrid / remote position.

Essential Duties and Responsibilities Fulfills requirements established by Community Health Solutions to complete monthly contacts with enrolled members.

Ensuring the information contained in the system of record is accurate and complete.

Provides members with education required to achieve optimal health maintenance and arranges appropriate education services, if necessary.Develops case specific care plans.Collaborate with the Care Advocate Team to ensure all required services, communications, documentation, and ancillary needs are addressed.

Maintains availability to members and providers to coordinate any required services.Serve as a member advocate.

Addresses and identifies complaints, grievances, or concerns and escalates to the appropriate stakeholder(s), when necessary.Identifies availability of advanced directives, needs for ancillary services, specialty services and community services.Upon member ineligibility or other circumstance in which disenrollment from the program becomes necessary, complete all needed activities to ensure continuation of care and communicate with all stakeholders to ensure an uninterrupted transition of care.

Serve as a mandated reporter.Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).

Supervisory Responsibilities LPN oversight Competencies: Strong organizational, interpersonal and motivational skillsExcellent written and verbal communication skillsDetail orientedHigh level of reasoning and analytical skillsAbility to multi-task and work independently Qualifications: Licensure as a Registered Nurse in the State of Florida.

A compact license is required, or provide documents that you are in the process.A Minimum of three (3) years of recent adult clinical experience is required.A bachelors degree in nursing is strongly preferred.

Certificates, Licenses, Registrations: Previous work experience with a Medicare program is preferred.Certified Case Management (CCM) Certification is preferred.

Bilingual (Spanish) is preferred.

Computer Skills: Demonstrated computer proficiency with Microsoft 365 products, electronic health record (EHR/EMR) systems, clinical data entry, telehealth platforms, Medicare documentation processes, and the ability to learn and navigate facility-specific software applications.Proficiency using software programs such as Microsoft Word, PowerPoint, Excel, Outlook, and Adobe Environmental Factors/Physical Demands This position is primarily performed from a remote home office.

The employee is responsible for maintaining a professional, safe, and secure home workspace with reliable high-speed internet access that suppo...