RN or SW MSW Health Plan Care Manager

Home visits in the counties of Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren.

About the role

Plans and prioritizes care for individuals and populations 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.

This position includes in-home, community-based work, as well as telephonic work. Works as part of an interdisciplinary care management team conducting in-home/in-community visits.

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; advocate and address any barriers to access needed services.
• Develop and prioritize plans to meet needs and provide services; follow up with families and community agencies to evaluate the effectiveness of services provided and plan for future needs.
• Develop plan of care and make recommendations to PCPs, specialists, and other members of the healthcare 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.
• Communicate and collaborate 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, interpret reports, and analyze data trends for groups of members.
• Document member data, plan, interventions, and outcomes according to department guidelines.
• Ensure processes and services are continuously monitored for quality, cost-effectiveness, and efficiency; engage in process and quality improvement activities.
• Make and implement recommendations to improve operational efficiency and to implement new services for areas of responsibility.
• Assess the educational needs of members, families, and members of the healthcare team; develop and implement appropriate teaching strategies or make referrals.
• Maintain knowledge of current trends and developments in the field.

Requirements

• Bachelor's Degree or equivalent in Nursing, or
• Master's Degree in Social Work
• 5 years of relevant experience
• LLMSW, LMSW, RN - clinical and/or case management/managed care or related field, OR Clinical Nursing and/or case management/managed care or related field
• Master Social Worker (MSW-Master) - State of Michigan (upon hire), or
• Registered Nurse (RN) - State of Michigan (upon hire)
• 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
• On-demand pay program powered by Payactiv
• Discounts directory with deals on 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
• Day shift
• 40 hours per week
• Monday to Friday