Remote Medicare- Bilingual Case Manager RN

Florida Blue

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Full-Time 32499

Job Summary
This key position is responsible for assisting members within a geographical (local, statewide and/or other) area make effective health care choices for self-management of their acute and /or chronic condition(s). Utilizing a member-centric approach they assist members and their families understand and manage their disease process by: reinforcing the physicians’ plan of treatment, promoting healthy behaviors and lifestyle changes, and providing education and tools to promote self- management to improve health outcomes and reduce overall costs. Individual care plans are developed in collaboration with the Physician, Member/Care Giver, Families and the Care Team. Ongoing coaching, monitoring and evaluation of care plans will be done face to face with the member, telephonically, digital engagement or electronically through email and member and provider portals.

Essential Functions

  • The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Engage Members telephonically, using digital engagement tools and/or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education. Facilitate access to care and resources to meet the member’s health care needs. Provide education and tools to promote self-management.
  • Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services, behavioral health and / or community resources.
  • Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed.
  • Close gaps in care
  • Conduct Medication Reconciliation
  • Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals.
  • Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses.
  • Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.


Required Work Experience
2+ years related work experience. Experience Details: Communicating and building relationships with members/providers/employers both telephonically as well as live. 2 years Clinical Experience

Required Management Experience
No supervisory/management experience required

Required Education
Related Bachelor’s degree or additional related equivalent work experience

Required Licenses and Certifications
RN – Registered Nurse – State Licensure And/Or Compact State Licensure

Additional Required Qualifications

Experience with influencing and motivating individuals to change health behaviors
Knowledge and/or experience with population health
Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management
Experience working with Managed Care products, benefits and services
Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business
Non-traditional working hours to meet the member’s availability
Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone .Basic technology skills with digital tools and apps.
Travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays
Must have valid driver’s license and reliable transportation

Preferred Education
Bachelor’s degree in a related field

Preferred Licenses and Certifications
CCM – Certified Case Manager

Additional Preferred Qualifications
Bilingual English/Spanish and/or Creole  Direct clinical experience (3-5 years)  Experience working remotely (i.e. home office)

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

  • Medical, dental, vision, life and global travel health insurance;
  • Income protection benefits: life insurance, Short- and long-term disability programs;
  • Leave programs to support personal circumstances;
  • Retirement Savings Plan includes employer contribution and employer match;
  • Paid time off, volunteer time off, and 11 holidays
  • Additional voluntary benefits available; and
  • A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $66,400 – $107,900

Typical Annualized Hiring Range: $66,400 – $83,000

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.