Community Based Care Manager, RN

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

📋 Description

• Collaborate with multidisciplinary care teams, healthcare providers, community organizations, and faith-based entities.

• Conduct health and psychosocial assessments that are strength-based and trauma-informed, utilizing motivational interviewing and a health-equity perspective.

• Facilitate meetings for interdisciplinary care teams.

• Engage with members in various settings, including hospitals, provider offices, community agencies, their homes, and via telephonic or electronic communication.

• Create and update individualized, person-centered care plans.

• Identify challenges and implement clinical interventions in line with established standards and best practices.

• Coordinate care, services, transitions, post-discharge needs, and appropriate levels of care.

• Educate members and their natural supports about treatment options, community resources, and insurance benefits.

• Document activities and assess member progress, responses, satisfaction, and concerns.

• Monitor healthcare resource utilization and manage clinical variance and benefits.

• Verify member eligibility, enrollment history, demographics, and health status.

• Oversee psychosocial and behavioral assessments and the execution of care plans.

• Inform providers about Care Management services and their benefits.

• Identify and address any gaps in care and access.

• Coordinate with community-based organizations, state agencies, and service providers.

• Provide clinical oversight to unlicensed team members.

• Enhance member-facing processes and communicate improvements to leadership.

• Travel regularly for visits with members, providers, and community-based organizations; travel may exceed 50%.

• Comply with NCQA and CMSA standards and perform other assigned duties.

⛳️ Requirements

• A nursing degree from an accredited nursing program is required.

• A current unrestricted Registered Nurse license in the state of practice is required.

• A minimum of three years of nursing experience is necessary.

• Three years of experience in Medicaid and/or Medicare managed care is preferred.

• An advanced degree related to clinical licensure is preferred.

• Case Management Certification is highly preferred.

• A valid driver’s license, vehicle, and verifiable insurance are required.

• Successful completion of a driver’s license record check and insurance verification is required.

• Influenza vaccination is required during the influenza season.

• A strong understanding of Quality, HEDIS, disease management, medication reconciliation, and adherence is essential.

• Intermediate proficiency in Microsoft Outlook, Word, and Excel is needed.

• Knowledge of healthcare laws, regulations, case management practices, and CMSA standards is required.

• Ability to interpret and apply current research findings is necessary.

• Strong skills in critical listening, thinking, decision-making, problem-solving, organization, and time management are required.

• Candidates must reside within the assigned territory.

🏝️ Benefits

• A bonus linked to company and individual performance may be available.

• A comprehensive total rewards package is offered.

• Reasonable accommodations for qualified individuals are provided.

• Influenza vaccination is offered/required as a condition of continued employment.

• Flexible working hours, including the possibility of evenings and weekends.

• Mobile work with travel to various settings is part of the role.