Case Manager, Registered Nurse – LTSS

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

📋 Description

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

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

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

• Utilize clinical judgment to identify risk factors, prevent unnecessary hospitalizations, and mitigate barriers to care.

• Coordinate 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 in response to 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.

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

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

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

⛳️ Requirements

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

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

• Minimum of 2 years of clinical nursing experience.

• At least 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 developing person-centered service plans.

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

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

• Proficient in electronic medical records and care management platforms.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Other resources, based on eligibility.