Case Management Nurse - Miami, Florida | CareerCircle
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Case Management Nurse



Posting ID: JP-002664610

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Miami, Florida
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The Complex Care Manager is responsible to assess all referred cases, plan, implement, perform interventions, coordinates services, monitor, and evaluate the options and services including psychosocial elements for high risk members, in an effort to ensure continuity of care for acute and chronic conditions. Point of contact across the continuum of care for assigned members. Promotes effective utilization of resources to obtain high quality, cost-effective outcomes. Coordinate care across care settings for members to include medical, behavioral health and social services to members when the need is identified through health risk assessment, predictive modeling, and utilization data.

1. Reviews the High Risk-High Cost, Emergency Room Utilization and High Risks Assessment Reports, referrals from concurrent review nurses, providers and internal departments, among others.

2. Performs comprehensive health assessment for identified members that meet criteria for admission into Case Management.

3. Obtains necessary information in order to identify needs, problems, and barriers to address member’s needs.

4. Assess the following areas:

o Health Status including conditions-specific issues

o Clinical History

o Medication reconciliation

o Activities of Daily Living

o Behavioral health status, including cognitive functions

o Psychosocial issues

o Cultural and linguistic needs, preference or limitations

o Visual and hearing needs, preference or limitations

o Caregiver resources and involvement

o Available benefits

o Available community resources

o Life Planning activities


medical management, Case management, Managed care, Treatment planning, Utilization review, Rn license, care planning, claims, claims resolution

Additional Skills & Qualifications:

Must be a RN and Bilingual with previous complex case management experience e

They work with both Medicare and Medicaid

Case load will vary anywhere from 50-70 but that can change

About Actalent:

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Contact Information

Recruiter: Jean Chambers

Phone: (410) 579-3072


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