Remote RN Case Manager – Michigan

Client: Large Health Insurance Organization

Start Date: ASAP

Title: RN Case Manager (Michigan)

Location: WFH – Michigan License

Duration: 2 months with potential extension

Scheduled Weekly Hours: 40 Hours

Essential Functions:

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member
• Engage with the member to establish an effective, professional relationship via telephonic or electronic communication
• Develop a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member’s desires, needs and preferences
• Identify and manage barriers to achievement of care plan goals
• Identify and implement effective interventions based on clinical standards and best practices
• Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management
• Facilitate coordination, communication and collaboration with the member the ICT in order to achieve goals and maximize positive member outcomes
• Educate the member/ natural supports about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made
• Employ ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP
• Evaluate member satisfaction through open communication and monitoring of concerns or issues
• Monitors and promotes effective utilization of healthcare resources through clinical variance and benefits management
• Verify eligibility, previous enrollment history, demographics and current health status of each member
• Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders
• Oversee (point of contact) timely psychosocial and behavioral assessments and the care planning and execution of meeting member needs
• Participate in meetings with providers to inform them of Care Management services and benefits available to members
• Assists with ICDS model of care orientation and training of both facility and community providers
• Identify and address gaps in care and access
• Collaborate with facility-based case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
• Coordinate with community-based case managers and other service providers to ensure coordination and avoid duplication of services
• Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required on going care coordination.
• Provide clinical oversight and direction to unlicensed team members as appropriate
• Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation
• Continuously assess for areas to improve the process to make the members’ experience with CareSource easier and shares with leadership to make it a standard, repeatable process
• Adherence to NCQA standards (CMSA standards below)
• Perform any other job duties as requested

Competencies, Knowledge and Skills:

• Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence
• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
• Ability to communicate effectively with a diverse group of individuals
• Ability to multi-task and work independently within a team environment
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
• Adhere to code of ethics that aligns with professional practice
• Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
• Strong advocate for members at all levels of care
• Strong understanding and sensitivity of all cultures and demographic diversity
• Ability to interpret and implement current research findings
• Awareness of community & state support resources
• Critical listening and thinking skills
• Decision making and problem-solving skills
• Strong organizational and time management skills
• needs of our members

Education and Experience:

• Nursing degree from an accredited nursing program or Bachelor’s degree in a health care field or equivalent years of relevant work experience is required
• Advanced degree associated with clinical licensure is preferred
• A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required
• Three (3) years Medicaid and/or Medicare managed care experience is preferred