Field Case Manager Registered Nurse coordinating care for dually eligible Medicare and Medicaid members in Southeast Michigan. Developing proactive care plans and collaborating with healthcare providers for member wellness.
Responsibilities
Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness
Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits
Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning
Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality
Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members
Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
Utilizes case management processes in compliance with regulatory and company policies and procedures
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation
Requirements
Minimum 3+ years clinical practical experience as a Registered Nurse (RN)
Must have active and unrestricted Michigan RN licensure
Must be willing and able to travel up to 25%-50% of the time in Wayne and Macomb Counties
Reliable transportation required
Mileage is reimbursed per our company expense reimbursement policy
Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint
Effective computer skills including navigating multiple systems and keyboarding
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation, and weight management programs
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