RN Job In Coral Gables, Florida
CARE MANAGER- Miami Aetna
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FL: Coral Gables
The Care Manager assessments, referrals, and triage. Conducts telephone assessments, collecting sufficient data to make appropriate referral and certification decisions for emergency/urgent referrals that require alternate levels of care.
ABOUT THE POSITION
We are currently seeking a dynamic Care Manager to join our team out of Miami, FL. The Care Manager assessments, referrals, and triage. Conducts telephone assessments, collecting sufficient data to make appropriate referral and certification decisions for emergency/urgent referrals that require alternate levels of care. Makes appropriate certification decisions. Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. Facilitates coordination of care with other care managers to assure continuity of care.
- Providing a timely outreach to new referrals
- Engaging members into the program by providing compelling rationale on the benefits of the program to fit the unique member's needs.
- Completing members needs assessment to determine appropriate services and inform the care plan.
- Developing an individualized member centric comprehensive care plan with input from the member, provider and family. The individual goals include: recovery and resiliency, decreasing symptomatology and/or increasing functional ability in areas such as self-care, work/school, and family/interpersonal relations in order to reduce barriers to treatment.
- Providing monitoring and reviewing of cases through planned outreach, incoming contacts, care coordination and utilizing rounds, weekly reports and individual supervision.
- Rounding or staffing with a supervisor takes place once per month at a minimum for difficult or challenging cases.
- Providing consultation and coordination with the behavioral health or medical providers, facility or, family members, s, community agencies, or involved medical practitioners regarding treatment and/or treatment planning issues.
- Providing motivational counseling and encourage self-advocacy to help sustain members' commitment to their care plans and treatment adherence.
- Coordinating and consulting with the UM Care Manager and medical care management as necessary Attending regularly scheduled rounds to consult with a psychiatrist or health plan staff and discuss cases and the need for continued intensive care management and outreach. Sending outreach letters to members who are not telephonically accessible or who do not respond to multiple telephonic outreach attempts.
- Frequency of outreach to the member, supports and provider(s) occur at a minimum one time per month, but more may be scheduled according to the member's clinical needs.
- Member's progress and CM interventions are documented appropriately in the care management system.
- Providing case closure/discharge at the time of completion.
- Follows all work flows meetings regulatory and accreditation requirements.
- Maintain a consistent caseload within parameters as defined by clinical leadership. Communicate as needed with clinical supervisor to address caseload
- Provide onsite case management, as assigned, to facilitate face to face interventions with providers and members.
- Refers cases that do not meet criteria and need non-decision to Peer Advisor
- 20% travel time
A minimum of a B.S. Degree in mental health field or an Associate's Degree in Nursing with related psychiatric nursing experience.
Licenses: Current valid and unrestricted license in a state or territory of the United States in a mental health field (RN, Ph.D, LMSW/LCSW, MHC, LLP, LPC, etc.) License in NJ
Relevant Work Experience:
3 - 5 years of direct practice experience in settings that include inpatient, partial, and/or outpatient preferred.. Strong customer orientation and excellent written and verbal communications skills required. Must possess strong computer skills.
Knowledge, Skills & Abilities:
- Proficient in word suite
- Excellent written and verbal communication skills
- Problem solving skills
- Excellent analytical skills
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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled
AAP Reporting Location:
FL - Coral Gables
ID (Req #):