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Care Manager I (RN)

Company: Sunshine State Health Plan
Location: Saint Cloud
Posted on: January 16, 2022

Job Description:

Position Purpose:Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care


  • Develop, assess and adjust, as necessary, the care plan and promote desired outcome

  • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options

  • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients

  • Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs

  • Provide patient and provider education

  • Facilitate member access to community based services

  • Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan

  • Actively participate in integrated team care management rounds

  • Identify related risk management quality concerns and report these scenarios to the appropriate resources

  • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
    Additional Details:

    • Hours: 8:30am-5pm with 1 hour lunch from 12-1pm.
      • Department: Children's Medical Services
        • Caseload: Pediatrics - Newborn to 21-year olds. Caseload of 40 members
          • Territory: Osceola County primarily. Can consider applicants that reside in Orange or Seminole Counties, too. Field/Local travel typically within county within 60 mile radius. Must reside in or be willing to relocate to the above mentioned area of Florida. Travel will be 75%.
            Our Comprehensive Benefits Package:

            • Flexible work solutions including remote options, hybrid work schedules and dress flexibility

            • Competitive pay

            • Paid Time Off including paid holidays

            • Health insurance coverage for you and dependents

            • 401(k) and stock purchase plans

            • Tuition reimbursement and best-in-class training and development
              Education/Experience:Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.

              Licenses/Certifications: Current state's RN license.

              For Sunshine Health (FL) Only: Employees supporting Florida's Children's Medical Services (CMS) must have a minimum of two years of pediatric experience.

Keywords: Sunshine State Health Plan, Melbourne , Care Manager I (RN), Executive , Saint Cloud, Florida

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