Rn Care Manager

ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary:

The RN Care Manager is responsible for care management and care coordination services of both Medicare and Medicaid benefits for members enrolled through Florida Complete Care (FC2) Medicare Institutional Special Needs Plan (ISNP) and Institutional Equivalent Special Needs Plan (IESNP) and the Statewide Medicaid Managed Care Program if applicable. The RN Care Manager serves as the designated lead staff, responsible for assessing member’s needs and establishing care plans to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and positive outcomes. The RN Care Manager behaves in a professional manner, and consistently demonstrates and promotes the values of respect, honesty, care, and dignity for the members as well as all other team members involved in the servicing of Florida Complete Care clients.

The RN Care Manager is involved in care management services inclusive of the Institutional Special Needs Plan (ISNP) and Institutional Equivalent Special Needs Plan (IESNP) and Medicaid Long Term Services and Supports Plan (LTSS). The Care Manager will be responsible for the collaborative development and initiation of individualized care plans using member health risk assessment, health plan reported utilization data, and other clinical, social and functional data. The RN Care Manager will be responsible for implementation of identified interventions based on developed care plans. Working closely with the member’s healthcare providers, the RN Care Manager will perform utilization management services on qualified services.

As the lead staff for management and coordination of both acute and long-term care needs, the RN Care Manager works collaboratively with members of the interdisciplinary care team. Emphasis is placed on seamless integration of care for enhanced member experience.

Essential Functions:

1. Serve as the primary point of contact to the member and their authorized representative
2. Assess member’s needs using the appropriate HRA and supplemental assessment tools
3. Complete face-to-face and telephonic care management/ coordination activities in a timely manner as established in policies and procedures
4. Development of individualized, comprehensive, person-centered care plan in conjunction with member/ authorized representative
5. Empower member to actively participate in the care planning process
6. Evaluate the effectiveness of the care plan in achieving established goals
7. Coordination of benefits regardless of the funding source, including informal services from the natural support system
8. Convene the ICT
9. Perform transition of care activities facilitating member’s safe and appropriate transition across different
10. Advocate on behalf of the member by ensuring that member is always at the center of the care process
11. Provide education to members and their authorized representatives regarding topics such as advance directive, disease specific, available resources as appropriate
12. Work closely with the Utilization Management team to coordinate benefits
13. Facilitate communication between the member’s care providers
14. Serve as a liaison between the member and the care delivery system
15. Facilitate and coordinate access to community resources
16. Identify the member’s primary care practitioner (PCP) and specialists involved in the member’s care/ treatment
17. Obtain required authorizations for release of information to coordinate and communicate with the PCP and other healthcare providers
18. Collaborate with member’s PCP and other healthcare providers in encouraging member to adopt healthy behaviors
19. Work closely with the SNF-based ICT and ensures member is included in the care planning process

Education:

• Registered Nurse, licensed in the State of Florida
• Graduate of an accredited School of Nursing
• 701B Comprehensive Assessment Certified
• 2+ years in case management

Experience:

• Knowledge of state and federal regulations including Medicare and Medicaid for the Statewide Medicaid Managed Care Program as well as Nursing Home regulations
• Familiarity with MS Office
• Effective and efficient time management skills
• Knowledge of acute care services for frail population that meet criteria for nursing home level of care
• Knowledge of Medicare regulations for the ISNP and IESNP products
• Knowledge of NCQA and AAAHC accreditations guidelines
• Knowledge of utilization management criteria including InterQual
• Ability to manage multiple priorities
• Ability to read, analyze and interpret complex documents
• Ability to efficiently respond to common inquiries or complaints from members, physicians, regulatory agencies, or members of the business community
• Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems
• Strong oral and written communication skills, bilingual is preferred
• Individual must show initiative and motivation and must demonstrate successful interpersonal relationship skills

EEO STATEMENT In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.