RN Field Care Manager – Medicaid HCBS/LTSS

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

📋 Description

• Evaluate the needs of members and assist them and their families in accessing suitable resources to achieve or maintain optimal health and wellness.

• Implement strategies to meet members' physical, environmental, and psychosocial health requirements.

• Oversee a caseload and conduct member assessments in home, community-based, and telephonic environments.

• Offer clinical support and guidance, especially for members with intricate medical needs.

• Create and coordinate care plans to guarantee the provision of appropriate services.

• Identify and address barriers to healthcare while advocating for the best possible outcomes for members.

• Review, assess, and finalize medical complexity attestations and clinical oversight activities.

• Evaluate care needs to ensure that services are delivered in the least restrictive environment.

• Develop and revise Individual Care Plans in collaboration with care team members, informal caregivers, coaches, and primary care providers.

• Assist members and caregivers in accessing social, housing, educational, and other essential services.

• Act as the primary liaison for the Interdisciplinary Care Team (ICT).

• Coordinate efforts with members, ICT participants, and external resources.

• Perform comprehensive InterRAI Integrated Health Care (IHC) assessments.

• Conduct Nursing Facility Level of Care Determinations (NFLOCDs).

• Facilitate accurate eligibility decisions and person-centered care planning.

• Ensure adherence to state Medicaid, LTSS, HCBS waiver, and regulatory requirements.

• Travel 75%–90% within Wayne and/or Macomb Counties for in-home visits.

⛳️ Requirements

• Must reside in Michigan, specifically in Wayne or Macomb Counties.

• Hold an active Michigan license as a Registered Nurse (RN) or Advanced Practice Registered Nurse (APRN), including Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS), with no disciplinary actions.

• Experience with Home and Community-Based Services (HCBS) and waiver programs.

• A minimum of 2 years of experience in healthcare and/or case management.

• Experience in conducting Long-Term Services and Supports (LTSS) assessments.

• Familiarity with Medicaid regulations.

• Proficient in applying person-centered planning principles.

• Experience working collaboratively with interdisciplinary teams, providers, members, and caregivers to perform comprehensive assessments and suggest suitable services.

• Ability to maintain timely, accurate, and compliant documentation in line with organizational, state, and federal standards.

• Knowledge of community health, social service agencies, and available community resources.

• Proficient in using electronic information systems and software programs, including electronic medical records (EMRs).

• Strong keyboarding and web navigation abilities.

• Intermediate to advanced computer skills, including proficiency in Microsoft Word, Outlook, and Excel.

• Valid state driver's license and personal vehicle liability insurance.

• Must complete TB screening.

• Bachelor of Science in Nursing (BSN) is preferred.

• Experience with InterRAI Integrated Health Care (IHC) assessments is preferred.

• Familiarity with conducting and documenting Nursing Facility Level of Care Determinations (NFLOCDs) is preferred.

• Experience in health promotion, coaching, and wellness is preferred.

• Previous experience in managed care is preferred.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability.

• Life insurance.

• Mileage reimbursement for eligible travel.

• Self-provided internet requirements for home or hybrid home/office employees.

• Occasional travel to Humana offices for training or meetings.