Case Management Nurse

Case Management Nurse

Solis Health Plans is looking for a Case Management Nurse (RN) who works for a health plan, assisting patients with complex medical needs to navigate the healthcare system and access appropriate care. The Case Management Nurse is responsible for coordinating and integrating care across different providers and settings, including hospitals, primary care offices, specialty clinics, and home care agencies.

Essential Duties and Responsibilities:

• Conducts comprehensive assessments of patients with complex medical needs to identify their physical, psychological, social, and environmental needs.
• Develops individualized care plans that address the patient's health goals, preferences, and priorities, and aligns with evidence-based clinical guidelines and best practices.
• Coordinates care across the healthcare continuum, including transitions of care between different settings and providers, and communicates with the patient, family, caregivers, and healthcare team members to ensure continuity and quality of care.
• Provides patient education on self-management of chronic conditions, medication management, preventive care, and healthcare navigation.
• Participates in quality improvement initiatives, evaluates the effectiveness of the care coordination and integration program and implements changes to improve outcomes and patient satisfaction.
• Maintains accurate and timely documentation of patient assessments, care plans, interventions, and outcomes, using electronic health record systems.
• Engages in ongoing professional development activities, such as continuing education, certification, and participation in professional organizations, to maintain and enhance knowledge and skills related to care coordination and integration.
• Collaborates with other members of the healthcare team, such as physicians, social workers, pharmacists, and case managers, to ensure that patients receive coordinated and integrated care that meets their needs and preferences.
• Works closely with the health plan's utilization management team to ensure that services are authorized and reimbursed appropriately.

Qualifications and Education:

• Nursing Degree from an accredited nursing program and be licensed as a registered nurse (RN) in the state of Florida. A clear and active license is required.
• 3 years of clinical experience as an RN is preferred.
• Certification in care coordination and transition management, Certified in Case Management (Preferred).
• Strong interpersonal and communication skills to effectively interact with patients, families, and healthcare team members. They must also have strong critical thinking, problem-solving, and decision-making skills to assess patient needs, develop care plans, and coordinate care across different settings and providers.
• Knowledge of evidence-based clinical guidelines, care coordination and integration models, healthcare systems and policies, and quality improvement methods.

Join Solis Health Plans as a Case Management Nurse and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!