Job duties include but are not limited to the following:
•Focus on Medicare Advantage Membership:
o To close gaps in care
o To encourage members to receive Medicare recommended Preventive Screenings
o To align activities with STAR initiative
• Assess, Plan, implement, coordinate and monitor Case/Oncology and Preventive activities that focus on acute and non-acute services, outpatient services and or community resources for the Medicare Advantage members, including (but not exclusively) those with a cancer diagnosis
• Serve as a point of contact for members to assist in navigating them through the continuum, educate regarding benefits, identify candidates for additional Care Programs and provide information pertaining to participating network and network access.
• Facilitate access to resources to meet member’s needs
• Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions
• Provide education and tools to promote self management.
• Collaborate with Medical Directors, Managers, Co-workers and other departments. May require off site visits with members and or physicians
Responsibilities are not all inclusive (e.g., project work may be requested in addition to other responsibilities) .
Current Florida RN license
3+ years of clinical experience in a hospital setting
Experience in one or more of the following: Oncology care/services, home health care, rehab, utilization review, discharge planning and case management
Recent experience with Case Management of Oncology patients.
Demonstrate the ability to establish and maintain collaborative relationships with Oncologists and other health care professionals to meet member needs and improve health outcomes
Knowledge and skills to help members with anticipatory guidance (symptom management, managing signs/symptoms as a complication of therapy--chemo/radiation, etc)
Experience with the Healthcare Industry (Managed Care)
Experience working with Medicare members
Experienced in MS Word and Excel
Occasional travel within the State of Florida
Travel up to 20% (subject to change)
Business Specific Criteria (preferred skills):
Bachelors degree in related field (i.e. Nursing, Healthcare, Business)
Experience in Case Management
Case Management certification
Experience working with MS Word and Excel