Location: This is a Remote/Member facing role where you will need to make home or facility visits to members 80% of the time, MI Market.

* Remote work, compact licensure required . May be required at times to work outside of MI remotely.

Shift: 8:00 am to 5:00 PM EST

Job Description: Position Purpose:

Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Education/Experience:

Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.

License/Certification:

RN - Registered Nurse - State Licensure and/or Compact State Licensure required. Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome

Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs

Identifies problems/barriers to care and provide appropriate care management interventions

Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services

Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs

Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate

Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services

May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits

Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

Other duties or responsibilities as assigned by people leader to meet business needs

Performs other duties as assigned

Walk me through the day-to-day responsibilities of this the role and a description of the project:

• Remote telephonic case management, Care manager (CM) follows model of care to assist member in managing health care needs.
• Conducts initial assessments, medication review, develops care plan with member, identifies member needs and connects member with appropriate resources to meet health care needs.
• Interacts with members care team, community services, vendors.
• Follows up with member every 30 days at minimum to review conditions, progress toward goals, and ensure member is receiving requested information and/or services.
• Provides education on member health plan and coverage and management of identified health conditions.

Describe the performance expectations/metrics for this individual and their team:

• CM caseload expectation is 75 actively managed members, Audit score of 90%or greater, Case duration 90 days.

Required Skills/Experience:

Preferred Skills/ Experience:

1.

Registered Nurse, 5 plus years clinical RN experience

1.

Medicare Case management experience

2.

Compact License

2.

CCM certification

3.

3.

Education Requirement:

Graduate of accredited RN program

Education Preferred:

RN, BSN

Software Skills Required:

Microsoft office products

Required Certifications:

Compact Preferred, CCM preferred

Required Testing: