Jobs at Community Care Plan (Now Hiring) — 11 open

Qualifications: 

• Bachelor’s Degree in Nursing. 
• Master’s Degree in Nursing (Preferred) 

Certificates and Licenses: 

• Registered Nurse licensure in the state of Florida
• Certified Case Manager (Preferred)

Experience:

1. Clinical Experience: 3-5 years of clinical experience including labor and delivery, high risk antepartum and NICU.
2. Experience in Managed Care/Health Plan Setting: 3-5 years of experience in a managed care, health plan, or insurance setting, particularly in maternal health or disease/case management roles.
3. Experience with Utilization Management and Care Coordination: Experience coordinating care across medical, maternal/child, and social service providers, including familiarity with utilization management processes, appeals, and authorizations.
4. Knowledge of Medicaid/Medicare Regulations: Experience working with Medicaid, Medicare, or other state and federal health care programs, including knowledge of relevant regulations and compliance requirements.
5. Knowledge of Microsoft Office and internet software
6. Knowledge of EPIC and/or JIVA (preferred)

Skills and Abilities:

1. Clinical Knowledge and Expertise:

• Strong understanding of maternal and child health, including high-risk pregnancy management, prenatal and postnatal care, and common complications.
• Knowledge of evidence-based practices and guidelines in maternal and child health, including breastfeeding promotion, nutritional assessments, and preventive screenings.

1. Care Coordination Skills:

• Proven ability to coordinate care across multiple providers and settings, ensuring seamless integration of services for mothers and newborns.
• Experience in developing individualized care plans, monitoring progress, and adjusting care strategies as needed.
• Proficient in assessing and managing the psychosocial, educational, and medical needs of pregnant members and their newborns.

1. Communication and Interpersonal Skills:

• Exceptional oral and written communication skills, including the ability to effectively engage and educate enrollees, families, and healthcare providers.
• Strong interpersonal skills with the ability to build and maintain effective, professional relationships with enrollees, care teams, and community resources.
• Ability to speak effectively before groups, including enrollees, healthcare professionals, and community stakeholders.

1. Problem-Solving and Critical Thinking:

• Demonstrated ability to assess complex situations, identify barriers to care, and develop creative solutions to improve health outcomes.
• Strong analytical skills to evaluate data, track clinical outcomes, and implement care strategies that reduce risks and enhance patient care.

Essential Duties and Responsibilities:

1. Client Intake and Assessment:

• Complete client intake on all referred or identified pregnant members across multiple lines of business, securing agreement to program participation.
• Conduct initial needs assessments to evaluate medical, psychosocial, and educational needs, and ensure a risk stratification is completed to determine level of care requirements.
• Develop individualized care plans that address medical, educational, and psychosocial needs, incorporating the enrollee and family in the care planning process.

1. Care Coordination and Follow-Up:

• Provide routine follow-up contact with enrollees and providers to ensure appointment compliance based on the level of care requirements.
• Ensure enrollees have an established medical home or assist in obtaining primary healthcare for both self and newborn, if needed.
• Provide care management throughout the entire pregnancy term, facilitating post-partum visits and the first well-baby examination to ensure linkage to ongoing primary care.

1. Education and Intervention:

• Create intervention and educational plans covering pregnancy knowledge, self-care behaviors, lifestyle counseling, and referral to community resources as applicable.
• Develop and provide educational materials suited to enrollees' educational levels, and review these with the enrollee/caregiver and healthcare provider.

1. Care Monitoring and Coordination:

• Monitor clinical outcomes, ensuring appropriately timed medical care, lab work, and self-monitoring, and assist with scheduling and compliance.
• Evaluate treatment plans, referring patients to contracted providers or community organizations as appropriate.
• Coordinate with community resources such as Healthy Start, WIC, SNAP, and others to support the health of the mom and newborn.

1. Specialty Care and Screening:

• Facilitate maternity care, ensuring compliance with screening and referral for HIV, Hepatitis B, and other requirements.
• Ensure obstetrical care providers offer clients Florida's Healthy Start Prenatal and Postnatal screenings in accordance with Florida Statutes.
• Notify the local county health department of any pregnant enrollee testing positive for Hepatitis B and report to state and local agencies on pregnancy and births as per contractual requirements.

1. Quality Improvement and Compliance:

• Coordinate with the Quality Improvement Department to collect necessary data and implement initiatives to meet or improve established benchmarks for obstetric-related quality HEDIS measures.
• Maintain individual client records, ensuring compliance with Federal and State guidelines and standards, and maintain confidential medical records for each patient.
• Refer to the Medical Director any questionable, quality, or inappropriate treatment regimen and/or care.

1. Communication and Collaboration:

• Interact with, assist, and educate physicians, hospital representatives, administrators, patients and their families, corporate representatives, and other healthcare providers regarding the High-Risk Pregnancy Management Program.
• Maintain professional relationships with external agencies such as AHCA, FHK, and Community Services, serving as an ombudsman as needed.

1. Additional Responsibilities:

• Participate in in-service training programs to enhance professional skills and knowledge.
• Assist in the coordination of services for transportation, food, shelter, finance, and mental health as identified.