- Professional
Role Overview: The Care Manager assists members who are appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager is responsible for engaging with the member, the member's caregiver, and providers to assess the plan and establish individualized goals for each member. Will facilitate and coordinate care for members while ensuring the quality and use of cost-effective resources. The position will serve as a single point of contact and act as an advocate for members in the care coordination program. In addition, the Care Manager/Coordinator will oversee these same care management activities within assigned practices to ensure the delivery of high-quality care management services in accordance with the Plan, NCQA standards, and federal and state standards and requirements.
Work Arrangement:
- Remote - Associate must reside in the state of Michigan.
Responsibilities:
- Assess members by telephone to determine care coordination and care management needs for all referred members.
- Completes a comprehensive person-centered assessment that includes physical health history, mental health history, social determinants of health, and supportive needs.
- Coordinates physical, behavioral health, and social services.
- Provides medication management, including regular medication reconciliation and support of medication adherence.
- Identifies problems/barriers for care coordination and appropriate care management interventions.
- Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
- Identifies goals and assigns priority with associated time frames for completion. Share goals with the members and family as appropriate.
- Identifies and implements the appropriate level of intervention based on the member’s needs and clinical progress.
- Schedules follow-up calls as necessary and makes appropriate referrals.
- Implement actions to address member issues.
- Documents progress towards meeting goals and resolving problems.
- Coordinates care and services with the Community Health Navigator, member, member caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
- Meets regularly with designated partners to identify members for care management and assist in reducing/resolving problems and/or barriers, enabling the Care Coordinator to provide members with high-quality care management services.
- Participate in regularly scheduled meetings as needed.
Education & Experience:
- Bachelor’s Degree in Nursing is preferred; a Michigan active RN license is required.
- 2 to 3 years of experience in Labor and Delivery clinical experience required.
- 3 to 5 years of Case Management experience preferred.
- Certified Case Manager (CCM) is preferred but not required.
Licensure:
- A current and unrestricted Registered Nurse (RN) in Michigan licensure is required.
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