What are the responsibilities and job description for the RN Care Manager Health Plan position at Priority Health?
Must have a MICHIGAN RN LICENSE
We are looking for an experienced RN to join our Medicaid care management team.
About Priority Health
We are the second largest and fastest growing health plan in Michigan focused on improving the health and lives across the state, and we couldn't do it without the incredible talent of our employees. It is their commitment that continues to drive our success as a nationally recognized nonprofit health benefits company. As part of the Corewell Health system, our team members have a unique ability to grow and advance their career while maintaining their seniority and benefits.
Scope of work
Plans and prioritizes care for individuals and population of patients, focusing on strategies that will promote optimal health within populations. Demonstrates expertise, current knowledge in care and management of a caseload of members of varying complexity and seeks to improve member, family, and health systems / community outcomes through the application of educational concepts / skills and preventive care in a managed care environment. Collaborate with providers, community organizations, and systems to coordinate care and ensure members and their families are connected to the resources needed to promote health and wellbeing, and advocate and address any barriers to access needed services.
SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name
PH - Care Management - Medicaid
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. - 5:00 p.m.
Days Worked
Monday - Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
We are looking for an experienced RN to join our Medicaid care management team.
About Priority Health
We are the second largest and fastest growing health plan in Michigan focused on improving the health and lives across the state, and we couldn't do it without the incredible talent of our employees. It is their commitment that continues to drive our success as a nationally recognized nonprofit health benefits company. As part of the Corewell Health system, our team members have a unique ability to grow and advance their career while maintaining their seniority and benefits.
Scope of work
Plans and prioritizes care for individuals and population of patients, focusing on strategies that will promote optimal health within populations. Demonstrates expertise, current knowledge in care and management of a caseload of members of varying complexity and seeks to improve member, family, and health systems / community outcomes through the application of educational concepts / skills and preventive care in a managed care environment. Collaborate with providers, community organizations, and systems to coordinate care and ensure members and their families are connected to the resources needed to promote health and wellbeing, and advocate and address any barriers to access needed services.
- Develops and prioritizes plans to meet needs and provides services. Follow up with families, and community agencies to evaluate effectiveness of services provided and plan for future needs.
- Develops plan of care and makes recommendations to PCPs, specialists and other members of the health care team regarding care management strategies, identifying strategies to maximize continuity of care across the continuum.
- Assess internal and external referrals to meet identified member and their family's needs, level of intensity, mandated reporting referrals, insurance benefits, and other member resources.
- Communicates and collaborates with member/significant others/providers/payers to coordinate services that improve access to appropriate services across the continuum of care and which promotes optimal health in a cost-effective manner.
- Measure member care outcomes, interprets reports, and analyzes data trends for groups of members.
- Documents member data, plan, interventions and outcomes according to department guidelines.
- Ensures processes and services are continuously monitored for quality, cost effectiveness, and efficiency, Engages in process and quality improvement activities. Makes and implements recommendations to improve operational efficiency and to implement new services for areas of responsibility,
- Assesses the educational needs of members, families and members of the health care team and develops and implements appropriate teaching strategies or makes referrals. Maintains knowledge of current trends and developments in the field
- Required Bachelor's Degree or equivalent Nursing
- 5 years of relevant experience Clinical Nursing and / case management/managed care Required
- Registered Nurse (RN) - State of Michigan Upon Hire required
- Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance, pet insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name
PH - Care Management - Medicaid
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. - 5:00 p.m.
Days Worked
Monday - Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
