Job Description
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Job Title:
Case Manager-RN Notes:
This fully remote Case Manager RN role is responsible for coordinating comprehensive, member-centered care for health plan members with complex medical, behavioral, and social needs. The RN serves as the primary point of contact for members, caregivers, providers, and community resources, using telephonic and digital communication channels to assess needs, develop individualized care plans, coordinate services, provide education, and monitor outcomes. The role requires collaboration with a multidisciplinary care team, strong care coordination skills, and the ability to address barriers that impacts health outcomes. Skills/Education/Experience:
Michigan RN active License and Nursing Degree 3 year clinical experience in an acute and community setting Case management and care coordination experience Telephonic and Digital patient management experience Experience working with multidisciplinary teams Knowledge of community resources and transitions of care CCM certification (or willingness to obtain) SUMMARY:
The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the online messaging platform The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member's health across the care continuum They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals ESSENTIAL DUTIES AND RESPONSIBILITIES
include the following. Other duties may be assigned:
Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members' health across the care continuum Assess the member's health, psychosocial needs, cultural preferences, and support systems Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services) Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family Advocate for members and promote self-advocacy Deliver education to include health literacy, self-management skills, medication plans, and nutrition Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary Accurately document interactions that support management of the member Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM) EDUCATION AND EXPERIENCE
Nursing Diploma or Associates degree in nursing required Bachelor's degree in nursing strongly preferred 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required 1 year of case management experience in a managed care setting strongly preferred Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred CERTIFICATES, LICENSES, REGISTRATIONS
Current, active, and unrestricted Michigan Registered Nurse license required Certification in Case Management (CCM) required or to be obtained within 18 months of hire Certification in Chronic Care Professional (CCP) preferred QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily The requirements listed below are representative of the knowledge, skill, and/or ability required Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions OTHER SKILLS AND ABILITIES
Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member's outcomes Empathetic, supportive and a good listener Proficient in motivational interviewing skills Demonstrated time management skills Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.) Must embrace teamwork but can also work independently Excellent interpersonal and communication skills both written and verbal Why work with us? We are a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work with us you'll have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! We are an EOE, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. https:
//www.optechus.com/eeo_self_identification/ The perfect fit is one click away. Refer A Friend Opportunities are meant to share. Corporate Headquarters 5440 Corporate Drive, Suite 260 Troy, MI 48098 Quick Links
