SIU Field Investigator responsible for investigating Florida PIP fraud in South Florida. Looking for bilingual candidates to manage complex claims and provide guidance on fraud detection.
About the role
- Registered Nurse Care Manager supporting individuals with complex medical needs at Pair Team. Working remotely with occasional community visits to ensure high-quality care and support.
Responsibilities
- Primarily work with and support a caseload of individuals with complex medical needs
- Work with individual to identify health/wellness goals and incorporate goals into a Shared Care Plan
- Educate individuals on medical and behavioral health conditions (including medication) to improve health literacy
- Provide medication reconciliation in collaboration with the individuals’s pharmacy
- Provide care management services such as coordinating prescriptions and completing prior authorizations
- Track and assure that all required assessments and screenings are performed
- Collaborate with multidisciplinary care team to identify and address barriers to care
- Identify clinical needs and triage escalations, providing brief interventions as necessary, with support from nurse practitioner clinicians
- Collaborate on care issues with Enhanced Care Management team by participating in systematic case reviews
- Consult with Enhanced Care Management team about clinical concerns or questions, provide educational training on chronic disease states, prevention, treatment, meds, and healthy living
- Build trust and develop relationships with individuals experiencing homelessness, living with Severe Mental Illness/Substance Use Disorder, and living with multiple chronic conditions
- Use relationship-based strategies to engage individuals in care, understanding that many may have lived personal experiences causing them to be initially hesitant or distrusting of the health care system
- Seeks to listen openly to individuals and meets them where they are – understanding that adopting an “it’s not my fault but it is my problem” attitude in all communication styles and approaches
Requirements
- Must hold active Registered Nurse license issued by the state of California
- Located in California (Preferred)
- Previous experience in care coordination or case management
- 2-3+ years of experience working for a health plan or at-risk provider
- Bilingual – English/Spanish
- Strong technical skills and comfort with new technology innovation, past experience with CRM databases, basic Google suite, email, and video conferencing
- Must have quiet and HIPAA-compliant at-home work environment with reliable Internet connection and cell phone
- Strong understanding of cultural fluency
- Demonstrated professional or personal lived experience working closely with individuals experiencing complex chronic needs, homelessness, or Severe Mental Illness/Substance Use Disorder
- Empathetic with a drive to reduce barriers to healthcare and social services for underserved communities.
Benefits
- Comprehensive health, vision & dental insurance
- 401k
- Opportunity for rapid career progression with plenty of room for personal growth!
- Monthly $100 work from home expense stipend
- Flexible vacation policy with unlimited time off
- Work entirely from the comfort of your own home - no office
- We provide the equipment needed for the role
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