Care Management Nurse Specialist (LPN)
Remote - any eligible state | Melbourne, FL
States we employ in: AL, AZ, CO, FL, GA, IA, IL, IN, NC, OH, SC, TN, TX, VA, WI, WV. In order for your candidacy to be considered, you must have established residency in one of these states or being willing to relocate.
The Care Management Nurse Specialist collaborates with Registered Nurses to facilitate for ill members a positive Medi-Share member-experience and assist in the researching, executing, and monitoring for cost-savings initiatives.
Essential Job Duties & Responsibilities
Works closely with the Care Management Manager, RN Care Managers, and other key departments to support and/or facilitate administrative processes that manage cost-savings for the Care Management population.
Sets up and manages casework to track program savings in IT systems (CSI, Casepac, Salesforce and Teams)
Manages savings tracker for the department and reports results to Manager
Researches and independently resolves issues pertaining to savings initiatives.
Researches and manages a savings resource database to include patient assistance programs
Correlates research results with opportunities for additional savings and makes recommendations
Works with providers/members to obtain updated plan of care
Assesses/triages individual cases for caseload management or referral to a RN
Responds promptly to member/provider requests for information.
Maintains an advanced understanding of cost management, provider services, and processing functions.
Communicates effectively with nurses, provider offices, members, and other key departments
Documents case work, all telephone conversations, correspondence, and tasks completely and accurately in appropriate IT systems
Meets service level agreements for assigned workload (SF and CSI queues)
Prays with internal and external customers as appropriate.
Essential Skills & Abilities
Strong organizational, prioritization, and process skills
Expert Excel skills; intermediate Microsoft office skills (Outlook, Teams, Word)
Intermediate knowledge of Salesforce, CSI/Eldorado use and documentation
Expert knowledge of all program guidelines
Intermediate research skills to using IT systems, internet, and phone
Accurate data collection, documentation, and analysis
Strong critical thinking abilities to correlate research findings with solutions
Strong communication skills that facilitate positive outcomes
Works independently and with a team regularly; performs assigned special projects with minimal assistance
Ability to comply with HIPAA, PHI, and all call compliance rules and regulations
Core Competencies/Demonstrable Behaviors
Collaborates – builds partnerships and works collaboratively with the RN Care Managers, pharmaceutical and healthcare providers, and members to meet objectives.
Optimizes Work Processes – knowing the most effective and efficient processes to get results with a focus on continuous improvement
Communicates Effectively – able to clearly communicate needs and engage others to achieve objectives
Action Oriented – enjoys the challenge of effecting savings and presents an attitude of willingness, enthusiasm, and urgency to meeting objectives
Drives Results – consistently achieves and/or looks for opportunities to obtain and report results
Education and/or Experience
LPN license required
1+ years of care coordination in a clinical setting required
Oncology experience preferred
This job has no supervisory responsibilities.
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