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What is your impact:
This position will provide oversight for the implementation of focused programs and interventions targeted to improve member and provider satisfaction, decrease costs, maximize quality, and improve clinical outcomes for our covered members. They will plan, develop, implement, and evaluate processes and guidelines for managing care across the health care continuum for Florida Blue Medicare's healthcare members enrolled in our programs.

What are your key responsibilities:
The essential functions listed represent the major duties of this role, additional duties may be assigned.
Plan, develop, implement, and evaluate processes and guidelines for managing care across the healthcare continuum for Medicare members enrolled in our programs.
Ongoing monitoring, evaluation, and revision of diagnostic and utilization triggers and stratification criteria used to identify appropriate members for intervention.
Oversees the development and implementation of various tools that incorporate peer reviewed clinical guidelines and represent “best practices
The individual will participate in the development and implementation of new case management strategies and initiatives, both internally and through external vendor partners when appropriate.

What is required:
3+ years related work experience. Experience Details: 3 years’ experience in case or disease management is required.
2+ years direct supervisory/management experience
RN - Registered Nurse - State Licensure And/Or Compact State Licensure Unrestricted Florida License Upon Hire
CCM - Certified Case Manager Upon Hire
Knowledge of process development, systems management, policy development and workflow design
Knowledge of chronic health conditions, evidence-based practice guidelines and clinical tools used to demonstrate compliance with practice recommendations
Proficient in the use/application of standard computer applications (word, access, excel, power point)
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

What is preferred:
Bachelor’s degree in a health-related field
Experience managing virtual teams
Experience with NCQA accreditation and/or CMS audit process

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.

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 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: $85,900 - $139,600
Typical Annualized Hiring Range: $85,900 - $107,400

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.