Registered Nurse (RN) - Case Management
Actalent
Tampa, FL

Remote Nurse Case Manager

Coach Nurse Job Description As a Coach Nurse, you will utilize clinical expertise to manage assigned post-ate Care patients' transition from an acute care setting to the home setting through telephonic outreach. You will provide education, coaching, and care coordination to accomplish the goals of the Post-Acute Care Program, which includes four different health plans. This is a telehealth role; calls automatically answer the next caller in queue. Candidates will be on the phone for 4 hours of their 8-hour shift. Responsibilities * Engage Post-Acute Care patients in the program and administer initial assessments, progress surveys, and discharge surveys to prevent readmissions. * Perform assessments that directly tie to reducing readmissions, such as educating members about their discharge instructions, ensuring a follow-up PCP appointment is in place, medication reconciliation, educating on the signs and symptoms of their condition, and referring to community resources and caregivers. * Work closely with the Post-Acute Care patient home health agency nurse and physicians to facilitate education and adherence to established healthcare goals and care plans. * Use clinical expertise to review utilization information concerning patient care and match those needs to available care options within the Post-Acute Care Program and specific plan payer guidelines. * Document all interactions, guidance, and interventions in applications. * Act as a clinical resource for Post-Acute Care Coordinators, assisting to clarify referral source directives. * Receive/respond to requests from unlicensed staff regarding scripted clinical questions. * Support ongoing reauthorization decisions for Post-Acute Care patients and issue service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines. * Contact referral sources to advise them of referral status and relay updates to the assigned health plan case manager. * Participate in and contribute to ongoing quality assessment/improvement activities, ensuring the collection of data for improved analysis and preparing reports as needed. * Provide evening and weekend coverage as required, subject to change based on business requirements. Essential Skills * Health care * Managed care * Utilization management * Telehealth * Care management * Disease management * Registered Nurse license (NY or IL required) * 5 full years of nursing experience (1-2 years of acute nursing experience required - e.g., emergency department, intensive care unit, critical care unit, med-surg, etc.) * Case management/triage experience (telehealth case management a plus!) * Strong communication skills * Ability to navigate through multiple systems/screens * Telehealth/remote work experience Additional Skills & Qualifications * Discharge planning experience * Experience in managed care * Prior experience with adult and geriatric nursing strongly preferred * Friendly and bright personalities preferred * Registered Nurse with a current and unrestricted multistate license * Expertise in telephonic case management * Excellent communication, problem-solving, and decision-making skills * Ability to effectively manage and prioritize tasks * Embrace values of accountability, consistency, engagement, empowerment, respect, and outstanding service * Demonstrated coachability or history of learning new Electronic Medical Record systems Work Environment 100% Work from Home - equipment will be provided. Training is 4-6 weeks, Monday to Friday, 8am-5pm EST. After training, the schedule includes 5x8 hour shifts, which must include Friday and Monday. One weekend day (Saturday or Sunday) is required, with days off possibly being Tuesday, Wednesday, and/or Thursday. The start time of the shift is 8am EST (candidates in CST must start at 7am). A 1-hour lunch and appropriate breaks are provided. No time off is allowed for the initial 90 days on-contract. The nurse is on an auto-dialer and must be comfortable working in a call center environment and sitting/working at a computer for 8 hours a day. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through: * Hiring diverse talent * Maintaining an inclusive environment through persistent self-reflection * Building a culture of care, engagement, and recognition with clear outcomes * Ensuring growth opportunities for our people The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [email protected] for other accommodation options.