- Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonically and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff, and Medical Directors.
- Utilize 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, psychosocial needs, cultural preferences, and support systems.
- Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promote improved overall health outcomes.
- 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.
- Advocate for members and promote self-advocacy.
- Deliver education to include health literacy, self-management skills, medication plans, and nutrition.
- Monitor and evaluate the effectiveness of the care management plan, assess adherence to the care plan to ensure progress to goals, and adjust and reevaluate as necessary.
- Accurately document interactions that support the management of the member.
- 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.
- 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 Certified Case Manager (CCM).
- Nursing Diploma or Associates degree in nursing required.
- Bachelor's degree in nursing strongly preferred.
- 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required.
- 1 year of case management experience in a managed care setting strongly preferred.
- Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.
- Current, active, and unrestricted Michigan Registered Nurse license required.
- Certification in Case Management (CCM) required or to be obtained within 18 months of hire.
- Certification in Chronic Care Professional (CCP) preferred.
- Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member's outcomes.
- Empathetic, supportive, and a good listener.
- Proficient in motivational interviewing skills.
- Demonstrated time management skills.
- Organizational skills with the ability to manage multiple systems/tools while simultaneously interacting with a member.
- Must have intermediate computer knowledge, typing capability, and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).
- Must embrace teamwork but can also work independently.
- Excellent interpersonal and communication skills both written and verbal.
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Case Manager - Plymouth, United States - HireTalent
Description
Title: Case Manager (Remote)Location: Remote - Field Lansing Michigan 48901
Duration: 12 months
Pay: $40.00/hr on W2
Department: SHS CM Program Delivery
Job Description:
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 various health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages, and the online messaging platform. The Care Manager RN utilizes 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.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
EDUCATION AND EXPERIENCE:
QUALIFICATIONS:
Note: This position supports SHS/EM/MA Fulfillment required with compact nursing license.
Need a basic computer test score and typing scores to be listed on the resume. In addition to the scores, we also need to have the state the individual resides in AND the state that holds the compact license, they should match. This is a requirement of BCBSM's HR, no flexibility there.
For any position that requires a license, please provide the license number and State that issued the license on the resumes or a copy of the license for validation. We need to know what State the license has been issued from in order to identify the primary state of residence.
