Pediatric Case Manager RN - Fort Lauderdale, FL (Remote & Field Based)

Company Description

Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Job Description

Broward County

Position Purpose:

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

• Develop, assess and adjust, as necessary, the care plan and promote desired outcome
• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
• Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
• Provide patient and provider education
• Facilitate member access to community based services
• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
• For LTSS - 30% travel to perform home visits to members
• For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required

Qualifications

Education/Experience:

Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.

Licenses/Certifications: Current state’s RN license.

For New Hampshire and Massachusetts: Candidates with RN license in good standing in other states than NH, must obtain a NH RN within 90 days of hire. Active driver’s license in good standing preferred.

For Arizona Complete Health - Complete Care Plan:
Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community)
Pediatric assignments require RN experience in pediatrics (clinical, acute care, community)

For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required.

LTSS Requirements:
Valid driver’s license and proof of car insurance.

For North Carolina only: Care Managers, this individual shall be responsible for conducting all functions and activities of the care management program and serve as the lead for each care management teams.

• Must reside in North Carolina
• Must be licensed practitioners
• Must be supervised by an RN, LCSW, or psychologist with trauma-based experience and training.
• Note: Care Manager for medical services is a NC - Licensed Registered Nurse in good standing. Care Manager for BH services in NC - Licensed LCSW in good standing.

Behavioral Health (BH) Managers and Full-Time BH Staff: These individuals shall be responsible for integrating into the clinical and care management teams to ensure Member’s behavioral health needs are fully integrated into the service delivery system.

• Must reside in North Carolina
• Experience working in behavioral health managed care and clinical setting
• Licensed behavioral health professional practicing within their scope

Additional Information

All your information will be kept confidential according to EEO guidelines.