BonitaSpringsRecruiter Since 2001
the smart solution for Bonita Springs jobs

Pediatric RN Field Case Manager - Lee and Collier County

Company: WellCare
Location: Bonita Springs
Posted on: March 21, 2020

Job Description:

Do your best work. Live your best life. If you thrive in a fast-paced, growth-oriented environment, WellCare is the place for you. Our clinicians have the ability to guide, educate and support members facing a diverse set of health challenges. You will gain valuable experience as you positively affect the lives you touch every day. As a clinical professional on the WellCare team, you will enjoy many advantages, including competitive salaries, generous benefits, job stability, continuing education and all the resources you need to advance in your career.

To learn more about this position Click Here to see a video.

Key Details:


  • Considering Registered Nurses with pediatric population experience who reside in Lee or Collier County).
  • This is a remote and field-based role serving in an assigned territory.
  • Ten in home/field visits required per week.
  • Strong computer skills needed for success.

    Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

    REPORTS TO: Manager, Field Care Management

    DEPARTMENT: Children's Medical Services (CMS)

    POSITION LOCATION: Lee or Collier County, FL

    JOB TYPE: Salary/Exempt

    Essential Functions:

    • Evaluates members for case management services and determines appropriate level of care coordination/ management services for member.
    • Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services.
    • Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description.
    • Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities.
    • Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
    • Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers).
    • Act as liaison and member advocate between the member/family, physician and facilities/agencies.
    • Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines.
    • Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues.
    • Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
    • Meets with clients in their homes, work-sites, physicians or hospital to provide management of services.
    • Adapts to changes in policies, procedures, new techniques and additional responsibilities.
    • Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds.
    • Perform other duties as assigned.


      Additional Responsibilities:


      • Travel to inpatient bedside, members home, providers office, hospitals, etc required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards. May require climbing multiple flights of stairs to a member's home, provider's office, etc.

        Candidate Education:

        • Required A Bachelor's Degree in Health Services or Nursing
        • Required or equivalent work experience

          Candidate Experience:

          • Required 2 years of experience in clinical acute care, post acute care, home health care, or maternity
          • Preferred 1 year of experience in current case management
          • Preferred Other Managed care experience
          • Preferred Other Prior utilization management experience preferred in some geographic regions
          • Preferred Other Experience in care of the elderly is required in some geographic regions
          • Preferred Other Experience in home health, physicians office or public health
          • Required Other Associates supporting Florida's Childrens Medical Services (CMS) must have a minimum of two (2) years experience in Pediatrics.
          • Required Other Work experience requirements may be waived for associates engaged in Florida's CMS contract that worked in a similar capacity for Florida's Department of Health in 2018.

            Candidate Skills:

            • Intermediate Ability to multi-task
            • Intermediate Ability to work independently
            • Intermediate Demonstrated time management and priority setting skills
            • Intermediate Demonstrated interpersonal/verbal communication skills
            • Intermediate Ability to create, review and interpret treatment plans
            • Intermediate Ability to implement process improvements
            • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
            • Intermediate Other Ability to understands the business and financial aspect of case mgmt in a managed care setting
            • Intermediate Knowledge of healthcare delivery
            • Intermediate Knowledge of community, state and federal laws and resources
            • Intermediate Demonstrated written communication skills
            • Intermediate Demonstrated customer service skills

              Licenses and Certifications:

              A license in one of the following is required:

              • Required Licensed Registered Nurse (RN)
              • Required Other Maintain required contact hours to fulfill regulatory requirements
              • Preferred Certified Case Manager (CCM)

                Technical Skills:

                • Required Intermediate Microsoft Word
                • Required Intermediate Microsoft Excel
                • Required Intermediate Microsoft Outlook
                • Required Intermediate Healthcare Management Systems (Generic)

                  Languages:

                  • Required Other In the state of NY, associates may be required to be proficient in one of two buckets of languages. Bucket one consists of the below:
                  • Required Bengali
                  • Required Other Bucket two consists of:
                  • Required Other Cantonese
                  • Required Other Fujianese

                    About us

                    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.

Keywords: WellCare, Bonita Springs , Pediatric RN Field Case Manager - Lee and Collier County, Executive , Bonita Springs, Florida

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Mosquito Management Aide
Description: Salary 13.00 Hourly - Location Sarasota, FL - Job Type Temporary Description This position is subject to
Company: Non Specific Employer
Location: Sarasota
Posted on: 04/3/2020

Travel Nurse RN - Case Management - $1,534 per week
Description: Travel Nurse Across America is seeking a travel nurse RN Case Management for a travel nursing job in Fort Myers, Florida:- Specialty: Case Management- Discipline: RN- Start Date: ASAP- Duration: 13 weeks- (more...)
Company: NurseFly Travel Nursing
Location: Fort Myers
Posted on: 04/2/2020

Account Manager (Pharmaceutical Sales Development Program)
Description: OTSUKA - PEOPLE CREATING NEW PRODUCTS FOR BETTER HEALTH WORLDWIDE We are looking for talented individuals to join our ReadyNow Sales Development Program If you love a fast-paced, ever-changing, challenging
Company: Otsuka
Location: Saint Petersburg
Posted on: 04/2/2020


RN / Registered Nurse / Florida / Any / Travel RN-Case Manager Job
Description: Specialty: RN Case ManagementLocations:Ft. Myers, Florida Shift: 8A to 4:30PDuration: 13 weeksStart Date: ASAPJob Details: ul li Responsible for coordinating medical care, and matching patient needs (more...)
Company: All Medical Personnel
Location: Fort Myers
Posted on: 04/3/2020

Assistant Regional Director
Description: Job Summary:Under general direction with a high level of autonomy, uses extensive knowledge and skills obtained through education and experience, to assist in the development and implementation of programs (more...)
Company: Raymond James Financial
Location: Saint Petersburg
Posted on: 04/3/2020

Director, Library Services
Description: Florida SouthWestern State College is accepting resumes in search of a Director, Library Services to join our team. This position provides leadership in the planning, direction, and evaluation of the (more...)
Company: Florida SouthWestern State College
Location: Fort Myers
Posted on: 04/2/2020

Lead Project Manager
Description: RESPONSIBILITIES Kforce has a client in search of a Lead Project Manager in Saint Petersburg, FL. Duties Include Under general supervision, uses specialized knowledge and skills obtained through education, (more...)
Company: Kforce Technology Staffing
Location: Saint Petersburg
Posted on: 04/2/2020

Site Director
Description: Description:The Weekend Event Staff - Site Director serves as the Adidas Jr. Gauntlet representative on site.-- They are responsible for:Entering Scores into tourneymachine.comAnswering any questions (more...)
Company: Alliance of American Football
Location: Bradenton
Posted on: 04/3/2020

System Director Of Nursing/Clinical Services
Description: Lee Physician Group is seeking an experienced RN to join their leadership team in the role of System Director of Nursing and Clinical Services. The ideal candidate will have 5 years of nursing leadership (more...)
Company: Lee Health
Location: Fort Myers
Posted on: 04/3/2020

Assistant Project Manager of Construction
Description: OverviewNRP Investments, LLC, founded in 1994, is a full-service developer, general contractor, and property manager of multifamily, senior, and student housing throughout the United States. From start (more...)
Company: The NRP Group
Location: Saint Petersburg
Posted on: 04/2/2020

Log In or Create An Account

Get the latest Florida jobs by following @recnetFL on Twitter!

Bonita Springs RSS job feeds