Anthem RN Case Manager (HIV Experience)- Jacksonville FL PS6231 in Tampa, Florida
RN Case Manager (HIV Experience)- Jacksonville FL PS6231
Location: Tampa, Florida, United States
Requisition #: PS6231
Post Date: Aug 06, 2018
Your Talent. Our Vision. At Simply Healthcare , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care .
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Location: Jacksonville FL
Eligible to work from a home office (remote) after successful completion of training and performance metrics.
RN Case Manager / RN Clinician - Managed Care Coordinator
Responsible for overall management of member’s case within the scope of licensure; provides direction to non-RN clinicians participating in the member’s case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member’s care plan to meet the member’s needs, with the goal of optimizing member health care across the care continuum.
• Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member’s needs, including physical health, behavioral health, social services and long term services and supports. Additional assessment tools for screening for member needs (i.e. Initial Assessment, HIV/AIDS Assessment, Diabetes Assessment, etc.)
• The ability to identify medications (prescription and over-the-counter) and allergies, including drug, food, or environmental. Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs such as Project AIDS Care or Long Term Care.
• The RN has overall responsibility to develop the care plan for services for the member and ensures the member’s access to those services.
• May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.
• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans.
• May also assist in problem solving with providers, claims or service issues.
• Directs the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member’s care plan to meet the member’s needs.
• Works with the SHP Claims Department in assisting with questions in the claims reconciliation process.
Requires a current, unrestricted RN license in Florida.
At least 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.
Strong computer skills preferred.
Masters in Health/Nursing preferred.
May require state-specified certification based on state law and/or contract.
PAC Waiver an/or Ryan White Waiver experience preferred.
Experience working with HIV patients preferred.
Previous Medicaid experience preferred.
Behavioral health experience preferred.
Simply Healthcare Plans is a Florida managed health care provider that serves Medicare and Medicaid members. Through our Clear Health Alliance organization, our health plan also serves Floridians who are eligible for HIV/AIDS Medicaid specialty health plan services. Along with our sister plan, Amerigroup Florida, we serve more than 600,000 Floridians who are members of our Medicare and Medicaid plans. Across the nation, our family of health plans serves nearly 40 million members, and 1 in 8 Americans is served by our family of companies. Our health plan members are assured care that is not only accessible, but also accountable, comprehensive, integrated and patient-centered. Each and every day, members of our team can be found in Florida communities, listening to our members, interacting with our health care providers and partnering with community-based organizations to execute health education initiatives. Our goal is to ensure members and entire communities are empowered to become active participants in their health care and sustain healthy lifestyles.