Title: Care Manager (RN)
Duration: 03 months with intent to convert to full-time
Location: Remote - Miami Dade & Monroe County (Region 11)
Work Arrangement: Remote with face-to-face visits
80% work from home, 30% travel based on caseload (50-mile radius)
Work Schedule: Monday – Friday, 8-5 EST (not flexible)
 

Position Summary: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high-quality, cost-effective healthcare outcomes.

Key Responsibilities:
 

• Required to complete daily outreach calls based on member-specific tiers.
• Based on members’ needs, the call volume will vary 5-20 calls per day.
• Contractual obligation is a weighted 200 caseload (Tier 3 – 2.2, Tier 4 - 1).
• Outreach calls are to check in on the members, follow up on their needs, remove any barriers to care for the members.
• Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost-effective care.
• Coordinate care (finding providers).
• Assisting in authorization.
• Creating assessments and care plans.
• Ensuring that the children’s needs are met (having issues at school, having a home health aide to assist).
• Leadership will complete chart and call audits on a monthly basis or as needed.

• 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.
• Performs other duties as assigned.
• Complies with all policies and standards

Candidate Requirements
Education/Certification	Required: Requires a Degree from an Accredited School of Nursing or a bachelor’s degree in nursing and 2 – 4 years of related experience.			Preferred: n/a
Licensure	Required: RN - Registered Nurse - State Licensure and/or Compact State Licensure required"			Preferred: n/a
Years of experience required Disqualifiers Best vs. average Performance indicators		Must haves: 2+ years of social work experience or licensed mental health counselor in an acute care or community setting. Experience connecting families/children to local resources for various services including employment, housing, independent living, justice, foster care, etc. Behavioral Health Experience Strong communication Time management Critical thinking Computer literacy and Microsoft office (excel) filtering, - moderate level   Nice to haves: Health plan experience Foster care and/or adoption experience Bi-Lingual Knowledge of government sponsored managed care programs preferred. Psych background as long as the license is there with it BA Case Management as a RN     Disqualifiers: Not meeting the 2+ years of peds experience Not being an RN   Performance indicators: Individuals will be audited monthly to ensure charts are in compliance. KPI metrics (are they meeting their monthly/quarterly outreach/ completing care plans, completion of annual assessments)
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection		1	Pediatric experience (2 years) – would love case management but not required precisely
		2	Bi-Lingual
		3	Behavioral Health Experience (training, certification, etc.)

Position is offered by a no fee agency. 

Location : Various, Various, Florida, United States, 99999 

 


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: $40.71/hr.