Care Manager, LVN LPN
Location: West Palm Beach
Posted on: December 5, 2019
Utilizes care coordination tools, criteria and protocols to provide
care coordination to lower acuity members with acute and chronic
health care needs. Provides education and support in assisting
members to achieve optimal level of wellness. Works with member to
support compliance with care and treatment plans in collaboration
with the interdisciplinary care team.
- REQUIRED: 4 years of experience with the pediatric population
Reports to: Supervisor of Field Care ManagementDepartment:
Children's Medical ServicesLocation: Palm Beach County, Florida
- Perform member interviews to assist with gathering of
- Perform follow up with members engaged in case management
- Facilitate provider contact as needed to coordinate member's
care needs. Initiates appropriate referrals and inputs
authorizations as needed for members active in case
- Support the identification of high-risk members for disease or
case management needs and works with member, physician and other
Health care providers to meet the member's individual needs.
- Identifies and escalates member cases with complex medical
needs to Supervisor or Manager.
- Act as liaison and member advocate between the member/family,
physician and facilities/agencies.
- 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.
- Instructs the member on how to access the program resources,
suggest and/ or arrange follow-up including mailing of educational
materials, contact with community resources, facilitate physician
- Documents all contacts in the Health Services clinical
- Manage members in disease management program, completing and
revising as necessary, the information in clinical documentation
- 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, physician?s or
hospital to provide management of services.
- Adapts to changes in policies, procedures, new techniques and
- Participates with other Case Managers and Medical Directors in
regular or special meetings such as Clinical rounds.
- Complies with all guidelines established by the Centers for
Medicare and Medicaid (CMS) and guidelines set forth by other
regulatory agencies, where applicable, and Corporate and department
policies and procedures.
- Identifies potential quality of care issues and appropriately
refers to the quality department.
- Assists in the implementation of specific strategies that
improve the quality and outcomes of care.
- Educates members and facilitates HEDIS gap closure.
- Performs all other duties assigned.
- Works under direct supervision of a Registered Nurse Additional
- Travel to inpatient bedside, member?s home, provider?s 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 High School or GED
- Preferred An Associate's Degree in nursing Candidate
- Required 2 years of experience in utilization management and/or
case management in a hospital or home health setting or with a
managed care organization.
- Preferred Other prior experience working with a geriatric
- Required Other In the Florida market, 4 years in pediatric
- 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.
- Intermediate Ability to drive multiple projects
- Intermediate Ability to multi-task
- Intermediate Ability to work in a fast paced environment with
- Intermediate Ability to work independently
- Intermediate Demonstrated time management and priority setting
- Intermediate Demonstrated interpersonal/verbal communication
- Intermediate Other Ability to provide input to care/treatment
- Intermediate Demonstrated negotiation skills
- Intermediate Ability to effectively present information and
respond to questions from families, members, and providers
- Intermediate Ability to implement process improvements Licenses
A license in one of the following is required:
- Required Other Current unrestricted LPN/LVN state license
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft PowerPoint
- Required Intermediate Microsoft Outlook Languages:
About usHeadquartered 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
Keywords: WellCare, Miami , Care Manager, LVN LPN, Executive , West Palm Beach, Florida
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