RN Care Manager LMSW Priority Health

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.

Responsibilities

• 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.

Qualifications

• Master's Degree in Social Work
• 5 years of relevant experience
• LMSW - clinical and/or case management/managed care or related field required
• Master Social Worker (MSW-Master) - State of Michigan Upon Hire required
• CRT-Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred

Benefits

• 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
• Traditional and Roth retirement options with service contribution and match savings

Schedule

Full time, 40 hours per week. Monday to Friday, day shift.

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