Title: Care Manager RN
Duration: 06 months (possibility to extend)
Location:  Remote- US (avoid CA)
Shift: 930-6pm EST

Job description:

Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.   Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.   License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure requiredEvaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome   Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs   Identifies problems/barriers to care and provide appropriate care management interventions   Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services   Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs   Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate   Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services   May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources   Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators   Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits   Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner   Other duties or responsibilities as assigned by people leader to meet business needs Performs other duties as assigned   Complies with all policies and standards Managed assigned worklist as well as pended worklist to make patient outreach providing clinical intervention. - Take inbound and make outbound calls. - Work collaboratively with other departments and the physician’s office to ensure best patient outcomes. - Manage emails, messages, and trainings daily. - Participate in trainings and meetings as needed. Specialty pharmacy experience Must be able to manage daily tasks with a high quality of work. - Goals will be given to the candidate to help them work towards the department’s expectations for success.   Candidate Requirements Education/Certification Required: Associate’s degree in nursing  Preferred: Licensure Required: Current State’s RN license Preferred: Years of experience required: 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.  Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.     Top 3 must-have hard skills stack-ranked by importance 1 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. 2 Knowledge of utilization management principles and healthcare managed care. 3

Position is offered by a no fee agency. 

Location : 6923 Lee Vista Blvd., Ste 300, Orlando, Florida, United States, 32822 

About Us: SPECTRAFORCE is one of the fastest-growing workforce solutions firms in the United States. As a diversity-owned business, we place human connection at the heart of everything we do, building strong relationships with both clients and candidates to fill roles successfully. Our teams in North and Central America and India serve more than 150 Fortune clients globally, leveraging custom AI technology to provide direct hire, executive search, nearshoring, offshoring, and project staffing solutions.
 
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
 
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
 
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer. 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $40.00/hr.