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Job Summary
This key position is responsible for assisting members within a geographical area make effective health care choices for self-management of their chronic condition(s). Utilizing a member-centric approach they assist members and their families understand and manage their disease process by: reinforcing the physicians' plan of treatment, promoting healthy behaviors and lifestyle changes, and providing education and tools to promote self- management to improve health outcomes and reduce overall costs. Individual care plans are developed in collaboration with the Physician, Member/Care Giver, Families and the Care Team. Ongoing coaching, monitoring and evaluation of care plans will be done face to face with the member, telephonically or electronically through email and member and provider portals.

 

Essential Functions

  • The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Engage Members telephonically or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education. Facilitate access to care and resources to meet the member’s health care needs. Provide education and tools to promote self-management.
  • Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services and or community resources.
  • Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed.
  • Close gaps in care
  • Conduct Medication Reconciliation
  • Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals.
  • Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses.
  • Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.
***** Must reside in the Broward county area****

 

Required Work Experience
2+ years related work experience or equivalent combination of transferable experience and education. Experience Details: Communicating and building relationships with members/providers/employers both telephonically as well as live


Required Licenses and Certifications
RN - Registered Nurse - State Licensure And/Or Compact State Licensure

Additional Required Qualifications

Experience with influencing and motivating individuals to change health behaviors
Knowledge and/or experience with population health
Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management
Experience working with Managed Care products, benefits and services
Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business
Non-traditional working hours to meet the member's availability
Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone
Travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays
Must have valid driver's license and reliable transportation


Preferred Education
Bachelor’s degree in a related field

Preferred Licenses and Certifications
CCM - Certified Case Manager

Additional Preferred Qualifications
• Bilingual English/Spanish

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Driving
Incidental Driving
We are an Equal Opportunity Employer/Protected Veteran/Disabled.

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