Case Manager, Registered Nurse – LTSS

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

📋 Description

• Perform thorough in-home Long-Term Services and Supports (LTSS) assessments to establish eligibility for waiver and community-based services.

• Complete and submit necessary waiver documentation following state Medicaid and health plan regulations.

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

• Utilize clinical judgment to identify risk factors, avert unnecessary hospitalizations, and eliminate barriers to care.

• Facilitate coordination of services among interdisciplinary teams, including providers, home health agencies, behavioral health, and community organizations.

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

• Track member progress and reassess needs based on any changes in condition or level of care.

• Present cases during interdisciplinary team (ICT) meetings and collaborate with supervisors and stakeholders to ensure achievement of goals.

• Maintain compliance with Medicaid waiver standards, CMS regulations, state LTSS guidelines, and organizational policies.

• Record all case management activities in line with regulatory and accreditation criteria.

• Provide education to members and caregivers about benefits, services, and accessible community resources.

• Act as a primary advocate for members and coordinate case management activities to promote overall wellness.

⛳️ Requirements

• Current, unrestricted Registered Nurse (RN) license in Michigan.

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

• At least 2 years of clinical nursing experience.

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

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

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

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

• Strong knowledge of social determinants of health and navigating community resources.

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

• Proficient with electronic medical records and care management software.

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

• Background in managed care or health plan settings.

• Knowledge of Michigan Medicaid waiver programs and state LTSS regulations.

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

• Bilingual skills are preferred.

• Strong clinical assessment and critical thinking abilities.

• Excellent communication and member engagement capabilities.

• Aptitude for managing a high-risk, complex caseload.

• Understanding of regulatory and compliance issues.

• Ability to make independent decisions in a remote setting.

• Capability to work autonomously.

• Proficient computer skills, including the ability to navigate multiple systems and keyboard effectively.

• Competence with standard corporate software applications, such as MS Word, Excel, Outlook, and PowerPoint.

• Dedicated workspace that is free from interruptions.

• Separate care arrangements for dependents during work hours.

🏝️ Benefits

• No evening, weekend, or major holiday shifts.

• 4 day/10-hour work schedule available post-training.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off benefits.

• Retirement savings options.

• Wellness programs available.

• Additional resources to support physical, emotional, and financial wellness.

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