Case Manager, Registered Nurse – LTSS

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Perform thorough in-home LTSS assessments to establish eligibility for waiver and community-based services.

• Complete and submit necessary waiver documentation in accordance with state Medicaid and health plan regulations.

• Create and execute personalized, person-centered care plans that address medical, behavioral, functional, and social determinant needs.

• Utilize clinical judgment to pinpoint risk factors, prevent unnecessary hospitalizations, and eliminate barriers to care.

• Coordinate services among interdisciplinary teams, healthcare providers, home health agencies, behavioral health professionals, and community organizations.

• Analyze claims data, clinical records, and assessment tools to assess member needs and benefit utilization.

• Track member progress and reassess needs in response to changes in condition or care requirements.

• Present cases during interdisciplinary team meetings and collaborate with supervisors and stakeholders to achieve objectives.

• Ensure adherence to Medicaid waiver requirements, CMS regulations, state LTSS guidelines, and organizational policies.

• Document case management activities in line with regulatory and accreditation standards.

• Educate members and caregivers about available benefits, services, and community resources.

• Travel 25–50% within designated counties for in-home field visits.

• Work remotely in a dedicated workspace free from interruptions during standard business hours.

⛳️ Requirements

• Active, unrestricted Registered Nurse (RN) license in the state of Michigan.

• Associate or Bachelor of Science in Nursing (BSN preferred).

• At least 2 years of clinical nursing experience.

• Minimum of 1 year of experience in case management, care coordination, home health, hospice, or long-term care.

• Experience with Medicare, Medicaid, or dual-eligible populations.

• Knowledge of Long-Term Services and Supports (LTSS), home and community-based services (HCBS), and waiver programs.

• Experience in conducting in-home assessments and creating person-centered service plans.

• Strong understanding of social determinants of health and navigation of community resources.

• Willingness to travel 25–50% within assigned counties, including completing in-home field visits; reliable transportation is required.

• Proficient in electronic medical records and care management systems.

• Experience in a managed care or health plan environment.

• Familiarity with Michigan Medicaid waiver programs and state LTSS regulations.

• Experience presenting cases in interdisciplinary team (ICT) settings.

• Strong clinical assessment and critical thinking abilities.

• Excellent communication and member engagement skills.

• Capability to manage a high-risk, complex caseload.

• Knowledge of regulatory and compliance standards.

• Ability to make independent decisions in a remote work setting.

• Capacity to work independently.

• Effective computer skills, including navigating multiple systems and proficient keyboarding.

• Proficiency in MS Word, Excel, Outlook, and PowerPoint.

• Bilingual skills preferred.

• Certified Case Manager (CCM) or a commitment to obtain certification within 2 years.

🏝️ Benefits

• No evening, weekend, or major holiday shifts.

• Option for a 4 day/10-hour work schedule following training.

• Comprehensive medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.