Job Description
Job Description
Title: Nurse Case Manager II - Transition OD Care Registered Nurse
Location: Miami-Dade County, FL
Shift: Mon-Fri 8am to 5pm
Duration: 6+ Months (Possibility of extension)
Pay rate: $37.98/hr
Candidate must reside in Miami-Dade County and will service Miami-Dade Co. and the Florida Keys and be able to travel to facilities within the regions/neighboring counties. Hours required are M - F 8am - 5 pm EST with some flexibility for start/ stop times. Local travel up to 75%. Applies critical thinking, evidence-based clinical criteria to support contractual rebalancing goals.
- Complete at least 10 NF member assessments weekly
- Support the Health Plan Rebalancing Initiative goal of successful transitions: Assess, identify, screen and transition NH members into the community
- Follow up on CM referrals and visit current NH members in-person at least twice a week to complete the rebalancing events and screening assessments.
- Complete telephonic or in-person contact to assess the home prior to discharge and identify any environmental supports needed to support transition (i.e. ramp, DME installation etc.).
- Conduct an in-person Significant Change Visit with member and Rep if applicable, within 5 days of transition. Coordinate provision of services as needed, establish Plan of Care, and document all actions taken.
- Contact facility’s Business Office once a week to follow-up on mbr’s census and will coordinate with Social Services and CM to facilitate discharge.
- Work collaboratively with case managers to identify high risk community members and implement appropriate interventions to prevent lapse or coordinate safe transition (Upon receiving referral)
- Drive enhanced value of health care to increase member satisfaction and retention, and drive new membership growth.
- Be involved in at least two community relations event per year
- Engage in building strong relationships that contribute towards member satisfaction and retention
Position Summary:
The Case Manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy to coordinate care and services that meet an individual’s benefit plan and health needs. This role promotes optimal, cost-effective outcomes through effective communication, resource utilization, and member engagement.
Duties & Responsibilities:
- Apply critical thinking and evidence-based clinical criteria to support contractual rebalancing goals.
- Complete a minimum of 10 Nursing Facility (NF) member assessments per week.
- Support the Health Plan Rebalancing Initiative by assessing, identifying, screening, and transitioning Nursing Home (NH) members into the community.
- Follow up on Case Management (CM) referrals and conduct in-person visits with current NH members at least twice weekly to complete rebalancing events and screening assessments.
- Conduct telephonic and in-person pre-discharge assessments to evaluate home environments and identify necessary supports (e.g., ramps, DME installation).
- Perform an in-person Significant Change Visit with the member and authorized representative (if applicable) within 5 days of transition.
- Coordinate services as needed, establish a Plan of Care, and document all actions taken.
- Contact the facility’s Business Office weekly to follow up on member census and coordinate discharge planning with Social Services and Case Management.
- Collaborate with Case Managers to identify high-risk community members and implement interventions to prevent lapses in care or ensure safe transitions upon referral.
- Drive enhanced healthcare value to improve member satisfaction, retention, and new membership growth.
- Participate in a minimum of two community relations events per year.
- Build and maintain strong relationships that support member satisfaction and retention.
Required Experience:
- Must reside in Florida and within the assigned coverage area.
- Minimum 2 years of clinical experience.
- Bilingual (Spanish/English) required.
- Willing and able to travel up to 75% of the time to meet members face-to-face within surrounding counties and areas.
Preferred Experience & Skills:
- Managed Care experience
- Discharge coordination experience
- Transition of Care experience
- Home Health experience
- Case Management experience
- Proficiency with computer systems and ability to navigate multiple platforms
- Ability to work effectively in a fast-paced environment
- Experience Level
- Mid-Level
Education & Licensure:
- Active, unrestricted, and good-standing RN license in the state of Florida (required)
- Associate Degree in Nursing (required)
- Bachelor of Science in Nursing (BSN) preferred