Field Care Registered Nurse
Location: Saint Louis
Posted on: June 15, 2019
Works with Care Coordination MVP Team members to assess, plan,
implement, coordinate, monitor, and evaluate services and outcomes
to maximize the health of the Member. Coordinates, monitors and
ensures that appropriate and timely primary, acute and long-term
care services are provided to members across the continuum of care.
Promotes effective healthcare utilization, monitors health care
resources and assumes a leadership role within the
Interdisciplinary Care Team (ICT) to achieve optimal clinical and
resource outcomes for member. Coordinates the care and services of
selected member populations across the continuum of illness.
Promotes effective utilization and monitors health care resources.
Assumes a leadership role within the interdisciplinary team to
achieve optimal clinical and resource outcomes. Works directly with
the member in the field, i.e., inpatient bedside, member's home,
provider's office, hospitals, etc. while collaborating with
management to assess, plan, implement, coordinate, monitor and
evaluate services and outcomes to maximize the health of the
member. Reports to: Supervisor of Field Care Management Department:
Population Health Services Location: St. Louis, Missouri
- Evaluates members for case management services and determines
appropriate level of care coordination/ management services for
- Completes a comprehensive assessment and develops a care plan
utilizing clinical expertise to evaluate the members need for
- Acts as a primary case manager for members identified as
Complex as defined by Case Management Program Description.
- Develops and monitors members plan of care, to include progress
toward meeting established goals and self-management
- Interacts continuously with member, family, physician(s), and
other providers utilizing clinical knowledge and expertise to
determine medical history and current status. Assess the options
for care including use of benefits and community resources to
update the care plan.
- Supervises and/or acts as a resource for non-clinical staff
(i.e., Service Coordinators and Field Social Workers).
- Act as liaison and member advocate between the member/family,
physician and facilities/agencies.
- Maintains accurate records of case management activities in the
Enterprise Medical Management Automation (EMMA) System using
- Coordinates community resources, with emphasis on medical,
behavioral, and social services. Applies case management standards,
maintains HIPAA standards and confidentiality of protected health
information and reports critical incidents and information
regarding quality of care issues.
- Ensures compliance with all state and federal regulations as
well as Corporate guidelines in day-to-day activities.
- Meets with clients in their homes, work-sites, physician's or
hospital to provide management of services.
- Adapts to changes in policies, procedures, new techniques and
- Participates with other Case Managers and Medical Directors in
regular or special meetings such as Clinical rounds.
- Perform other duties as assigned. Additional Responsibilities:
- Travel to inpatient bedside, member's home, provider's office,
hospitals, etc required with dependable car. May spend up to 70% of
time traveling with exposure to inclement weather and normal road
hazards. May require climbing multiple flights of stairs to a
member's home, provider's office, etc. Candidate Education:
- Required A Bachelor's Degree in Health Services or Nursing
- Required or equivalent work experience Candidate Experience:
- Required 2 years of experience in clinical acute care, post
acute care, home health care, or maternity
- Preferred 1 year of experience in current case management
- Preferred Other Managed care experience
- Preferred Other Prior utilization management experience
preferred in some geographic regions
- Preferred Other Experience in care of the elderly is required
in some geographic regions
- Preferred Other Experience in home health, physicians office or
- Required Other Associates supporting Florida's Children's
Medical Services (CMS) must have a minimum of two (2) years'
experience in Pediatrics.
- Required Other Work experience requirements may be waived for
associates engaged in Florida's CMS contract that worked in a
similar capacity for Florida's Department of Health in 2018.
- Intermediate Ability to multi-task
- Intermediate Ability to work independently
- Intermediate Demonstrated time management and priority setting
- Intermediate Demonstrated interpersonal/verbal communication
- Intermediate Ability to create, review and interpret treatment
- Intermediate Ability to implement process improvements
- Intermediate Ability to effectively present information and
respond to questions from families, members, and providers
- Intermediate Other Ability to understands the business and
financial aspect of case mgmt in a managed care setting
- Intermediate Knowledge of healthcare delivery
- Intermediate Knowledge of community, state and federal laws and
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated customer service skills Licenses and
A license in one of the following is required:
- Required Licensed Registered Nurse (RN)
- Required Other Maintain required contact hours to fulfill
- Preferred Certified Case Manager (CCM) Technical Skills:
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Outlook
- Required Intermediate Healthcare Management Systems (Generic)
- Required Other In the state of NY, associates may be required
to be proficient in one of two buckets of languages. Bucket one
consists of the below:
- Required Bengali
- Required Other Bucket two consists of:
- Required Other Cantonese
- Required Other Fujianese About usHeadquartered in Tampa, Fla.,
WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on
providing government-sponsored managed care services to families,
children, seniors and individuals with complex medical needs
primarily through Medicaid, Medicare Advantage and Medicare
Prescription Drug Plans, as well as individuals in the Health
Insurance Marketplace. WellCare serves approximately 5.5 million
members nationwide as of September 30, 2018. WellCare is a Fortune
500 company that employs nearly 12,000 associates across the
country and was ranked a "World's Most Admired Company" in 2018 by
Fortune magazine. For more information about WellCare, please visit
the company's website at . EOE: All qualified applicants shall
receive consideration for employment without regard to race, color,
religion, creed, age, sex, pregnancy, veteran status, marital
status, sexual orientation, gender identity or expression, national
origin, ancestry, disability, genetic information, childbirth or
related medical condition or other legally protected basis
protected by applicable federal or state law except where a bona
fide occupational qualification applies. Comprehensive Health
Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Keywords: Wellcare, St. Louis , Field Care Registered Nurse, Healthcare , Saint Louis, Missouri
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