Case Management Nurse Jobs

Position Summary

A CCIP Nurse (Care Coordination and Integration Program Nurse)/ Case Management Nurse is a registered nurse who works for a health plan, assisting patients with complex medical needs to navigate the healthcare system and access appropriate care. The CCIP Nurse is responsible for coordinating and integrating care across different providers and settings, including hospitals, primary care offices, specialty clinics, and home care agencies.

Essential Duties & Responsibilities

• Provides patient education on self-management of chronic conditions, medication management, preventive care, and healthcare navigation.
• Coordinates care across the healthcare continuum, including transitions of care between different settings and providers, and communicates with the patient, family, caregivers, and healthcare team members to ensure continuity and quality of care.
• Collaborates with other members of the healthcare team, such as physicians, social workers, pharmacists, and case managers, to ensure that patients receive coordinated and integrated care that meets their needs and preferences.
• Maintains accurate and timely documentation of patient assessments, care plans, interventions, and outcomes, using electronic health record systems.
• Participates in quality improvement initiatives, evaluates the effectiveness of the care coordination and integration program, and implements changes to improve outcomes and patient satisfaction.
• Engages in ongoing professional development activities, such as continuing education, certification, and participation in professional organizations, to maintain and enhance knowledge and skills related to care coordination and integration.
• Develops individualized care plans that address the patient's health goals, preferences, and priorities, and align with evidence-based clinical guidelines and best practices.
• Works closely with the health plan's utilization management team to ensure that services are authorized and reimbursed appropriately.
• Conducts comprehensive assessments of patients with complex medical needs to identify their physical, psychological, social, and environmental needs.

Qualifications & Education

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong interpersonal and communication skills to effectively interact with patients, families, and healthcare team members. They must also have strong critical thinking, problem-solving, and decision-making skills to assess patient needs, develop care plans, and coordinate care across different settings and providers.
• 3 years of clinical experience as an RN in acute care, community, or home health settings, and
• Nursing Degree from an accredited nursing program and be licensed as a registered nurse (RN) in the state of Florida
• Knowledge of evidence-based clinical guidelines, care coordination and integration models, healthcare systems and policies, and quality improvement methods.
• Certification in care coordination and transition management, such as the Certified in Care Coordination and Transition Management (CCCTM) credential offered by the Medical-Surgical Nursing Certification Board (Preferred)

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Interacts with members, vendors, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.
• Fast pace office environment.
• The noise level in the work environment is usually moderate.
• Highly regulated environment.

This work may require the following physical activities: climbing, bending, stooping, kneeling, twisting, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lift, and moves intermittently during working hours.

Work schedule is approximate and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays as needed.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 25 pounds and occasionally lift and/or move up to 35 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required to this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

This may be modified at any time at the discretion of the employer as business operation may deem necessary.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.

Solis Health Plans provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.