Case Manager-Registered Nurse
Location:
Remote-must have a Michigan License
Schedule:
Monday-Friday
Type:
W2 Contract
Duration:
Long term on-going with potential for direct hire
Pay Rate:
$36-$39 an hour with Benefits!
Position Summary
The Case Manager RN coordinates and leads a multidisciplinary care team to deliver holistic, member-centered care management services for diverse health plan populations with complex medical, behavioral, and social needs. Serving as the primary point of contact for members, caregivers, and providers, this role utilizes telephonic and digital communication channels to assess needs, develop individualized care plans, coordinate services, and improve overall health outcomes across the continuum of care.
Key Responsibilities
- Lead and coordinate a multidisciplinary care team consisting of Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff, and Medical Directors.
- Conduct comprehensive assessments of members’ medical, psychosocial, cultural, and support system needs.
- Develop, implement, monitor, and evaluate individualized care plans using the case management process.
- Collaborate with members, caregivers, healthcare providers, and community organizations to address care gaps and barriers to treatment.
- Coordinate healthcare services, community resources, behavioral health support, substance abuse services, financial assistance programs, and disease-specific resources.
- Facilitate communication and care coordination among providers, family members, community agencies, and support systems.
- Advocate for members while promoting self-management and self-advocacy skills.
- Provide education on health literacy, medication adherence, nutrition, chronic disease management, and preventive care.
- Monitor member progress toward care plan goals and adjust interventions as necessary to optimize outcomes.
- Document all member interactions, assessments, care plans, and interventions accurately and timely.
- Coordinate care transitions, including discharge planning from healthcare facilities to home or alternate care settings.
- Educate members and caregivers regarding post-discharge care, follow-up appointments, and continuity of care requirements.
- Arrange durable medical equipment (DME), transportation services, and other support services needed to ensure successful care transitions.
- Maintain compliance with organizational standards, quality measures, productivity goals, and regulatory requirements.
- Participate in ongoing professional development activities and maintain case management competencies.
Required Qualifications
Education
- Nursing Diploma or Associate Degree in Nursing required.
- Bachelor’s Degree in Nursing (BSN) preferred.
Experience
- Minimum 3 years of clinical nursing experience in acute care, post-acute care, community health, or clinical environments.
- Case management experience within a managed care setting preferred.
- Experience managing patients through telephonic and digital engagement platforms preferred.
Licensure & Certifications
- Current, active, unrestricted Michigan Registered Nurse (RN) license required.
- Certified Case Manager (CCM) certification preferred.
- Certified Chronic Care Professional (CCP) certification preferred.
Knowledge, Skills & Abilities
- Strong critical thinking, problem-solving, and clinical decision-making skills.
- Experience assessing complex medical, behavioral health, and social determinants of health needs.
- Effective motivational interviewing and member engagement skills.
- Excellent time management and organizational abilities.
- Ability to manage multiple systems, applications, and workflows simultaneously.
- Proficient with Microsoft Office applications, including Outlook, Word, Excel, Teams, and OneNote.
- Strong written and verbal communication skills.
- Ability to work independently while collaborating effectively within a multidisciplinary team environment.
- Compassionate, empathetic, and member-focused approach to care management.
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