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Wellcare

Field Care Manager RN - NICU

Wellcare - Columbus, GA

Field Care Manager RN - NICU','1704058','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!PLEASE NOTE: THIS IS A WORK FROM HOME OPPORTUNITY.

POSITION TO BE LOCATED IN COLUMBUS, AUGUSTA, SAVANNAH OR MACON, GA

 

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: Senior Director, Field Health Services

Department: Health Services

Position Location: Columbus, GA OR Macon, GA, OR Augusta, GA or Savannah, GA 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, physician’s 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, 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.

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 ','!*!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

Preferred 3 years of experience in NICU  

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 Candidate Skills:

Intermediate Ability to multi-task Bilingual skills a plus

Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload

Intermediate Demonstrated time management and priority setting skills

Intermediate Demonstrated interpersonal/verbal communication skills

Intermediate Ability to create, review and interpret treatment plans 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 Proficient in Microsoft Office including Excel, Word, PowerPoint, Access and Outlook Express

Required Intermediate Microsoft Excel Knowledge of or the ability to learn company approved software such as CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties

Required Intermediate Microsoft Outlook

Required Intermediate Healthcare Management Systems (Generic) Languages:

Required Other For the state of NY, associates have to be proficient in one of two buckets of languages. Bucket one consists of the below:

Required Other Bucket two consists of: ','US-GA-Columbus','33 West 11th Street','1st Floor, Suite 101','Columbus','31901','US-GA-Augusta, US-GA-Macon, US-GA-Savannah','Yes, 75 % of the Time','No','No','Field Care Manager RN - NICU'

5 days 1 hour ago

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Field Care Manager RN - NICU Wellcare - Columbus, GA, United States

   

Location: Columbus, GA

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.