The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members and their families using a variety of digital channels to meet members where they are. The Care Manager RN uses the case management process to assess, develop, implement, monitor and evaluate care plans designed to optimize the member’s health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.
Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs. This team will work with internal and external partners to maximize impact.
Use the case management process to assess, develop, implement, monitor and evaluate care plans designed to optimize the members’ health across the care continuum.
Assess the member's health and psychosocial needs and support systems and consider their cultural preferences.
Engage the member and/or caregiver to develop an individualized plan of care.
Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services).
Coordinate care delivery and support among member support systems, including providers, community-based agencies and family.
Deliver education to include health literacy, self-management skills, medication plans, nutrition, weight management etc.
Monitor and evaluate effectiveness of the care management plan and change as necessary.
Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care. Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.
Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
Assess adherence to care plan and report feedback to necessary stakeholders (e.g., PCPs, caregivers).
Measure and document results of the care plan toward meeting members’ goals.
Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals.
Continue professional development by completing relevant continuing education and maintaining CMC (Case Manager Certification).
" Qualifications"
EDUCATION AND/OR EXPERIENCE
Nursing Diploma or Associates degree in nursing required
Bachelor’s degree in nursing preferred
2 years of clinical nursing experience in a clinical, acute care, or community setting required
1 year of case management experience in a managed care setting strongly preferred
Current, active and unrestricted Michigan Registered Nurse license required
Certification in Case Management (CCM) preferred or to be obtained within 12 months of hire
Certification in Chronic Care Professional (CCP) preferred
OTHER SKILLS AND ABILITIES
Be a critical thinker with the ability to think outside the box on a large variety of topics
Strong decision making and problem-solving skills
Empathetic, supportive and a good listener
Proficient in motivational interviewing
Demonstrated time management skills
Ability to multi-task, while still being thorough when dealing with members
Must have intermediate computer knowledge, typing capability and proficiency in Microsoft Word and Outlook
Must embrace team work, but enjoy working independently
Excellent interpersonal and communication skills both written and verbal
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
