*Case Manager, RN Req'd Medically Fragile - Rocky Point','1704540','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!Location Rocky Point
Reports to Manager, Case Management
Medically Fragile Population Experience Required
Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the Supervisor / Manager of Case Management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the Member. Essential Functions:
Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
Coordinates community resources with emphasis on medical, behavioral and social services. Applies case management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.
Outreaches to members telephonically and/or in-person and coordinates member's case management services.
In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establishes case management objectives.
Requests consultation and diagnostic reports from network specialists.
Performs special projects as assigned. Additional Responsibilities:
Case load may differ by state and/or location based on contract requirements, membership, plan and/or operational best practice.
Some states and/or locations may require nurses to occasionally travel to facility or inpatient bedside to conduct assessments or face to face visits. ','!*!Candidate Education:
Required An Associate's Degree in nursing or graduation from Diploma Nursing School
Preferred A Bachelor's Degree in nursing or related field Candidate Experience:
Required 2 years of experience in a clinical acute care position(s), preferably in home health, physicians office or public health
Preferred 1 year of experience in current case management experience
Preferred 2 years of experience in appropriate experience and qualifications required to assessing members individual needs
Preferred 2 years of experience in physical health, aging and loss, appropriate support services in the community, frequently used medications and their potential side effects, depression, challenging behaviors, Alzheimer's disease and other disease related dementias, behavioral health, and issues related to accessing and using durable medical equipment, as appropriate. Candidate Skills:
Intermediate Ability to drive multiple projects a plus
Intermediate Ability to multi-task
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
Intermediate Demonstrated time management and priority setting skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans
Intermediate Demonstrated negotiation skills
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Ability to effectively present information and respond to questions from peers and management
Intermediate Ability to implement process improvements Licenses and Certifications:A license in one of the following is required:
Required Licensed Registered Nurse (RN)
Preferred Certified Case Manager (CCM) Technical Skills:
Required Beginner Microsoft Excel Intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express
Required Beginner Microsoft Word
Required Beginner Healthcare Management Systems (Generic)
Required Beginner Microsoft Outlook Languages:
Preferred Other Bilingual skills ','US-FL-Tampa','3031 N Rocky Point Drive, W','Suite 600, Harborview Plaza','Tampa','33607','','No','No','No','*Case Manager, RN Req'd Medically Fragile - Rocky Point'
Website : http://www.wellcare.com
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.