Nurse Case Manager II - Michigan

Candidates do not have to reside in Michigan; but they do need to have a valid and unrestricted RN license for the state of Michigan
Add city, state, and county at the top of your resume.
Standard business hours: Monday - Friday 8:00 am - 5:00 pm EST. Primarily telephonic. No field work needed for this role. Candidates will need a quiet, dedicated work space with no distractions. This role will require that the candidate be hard wired into the modem. Candidates will need to secure a long enough ethernet cord at their own expense.
Must have an active and unrestricted RN license in the state of Michigan.
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual\'s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member\'s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member\'s benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member\'s needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Duties
50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the members identified needs.
Provides evidence-based disease management education and support to help the member achieve health goals.
Ensure the appropriate members of the interdisciplinary care team are involved in the members care.
Provides care coordination to support a seamless health care experience for the member.
Meticulous documentation of care management activity in the members electronic health record.
Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the members stable health condition.
Identifies and connects members with health plan benefits and community resources.
Meets regulatory requirements within specified timelines.
The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.
Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
Conduct oneself with integrity, professionalism, and self-direction.
Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
Familiarity with community resources and services.
Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
Maintain strong collaborative and professional relationships with members and colleagues.
Communicate effectively, both verbally and in writing.
Excellent customer service and engagement skills.

Experience
Must have active and unrestricted Registered Nurse (RN) Licensure MI single state
Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role.
Access to a private, dedicated space to conduct work effectively to meet The requirements of the position.
Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
Minimum 3%2B years of nursing experience
Minimum 2%2B years of case management, discharge planning and/or home healthcare coordination experience
Experience providing care management for Medicare and/or Medicaid members.
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
Experience conducting health-related assessments and facilitating the care planning process.
Bilingual skills, especially English-Spanish, preferred not required

Position Summary
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Requires an RN with unrestricted active license for state of MI

Education
RN with current unrestricted state licensure.
Associates of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
Case Management Certification CCM preferred

What days & hours will the person work in this position List training hours, if different.
Monday-Friday 8a-5p EST