Case Manager RN - Michigan Remote

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary: This will be a full-time telework role in Southern Michigan. However, must be willing and reputed company to travel up to 15% of their time using their own vehicle to meet members reputed company the Detroit area and as needed office based meetings. The working schedule is Monday-Friday... reputed company-5pm EST. Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating reputed company case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Utilizes reputed company judgment and critical thinking skills to facilitate appropriate member physical health and behavioral reputed company through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and reputed company, cost-effective outcomes. reputed company Components & Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address reputed company clinical indicators which reputed company planning and resolution of member issues. Using reputed company skills, performs crisis reputed company with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Enhancement of Medical Appropriateness and Quality of Care: • Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits • Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to reputed company reputed company outcomes • Identifies and escalates quality of care issues through established channels • Ability to speak to medical and behavioral health professionals to influence appropriate member care. • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/ behavior changes to reputed company reputed company level of health • Provides coaching, information and support to reputed company the member to reputed company ongoing independent medical and/or healthy lifestyle choices. • Helps member actively and knowledgably participate with their provider in reputed company decision-making • Analyzes reputed company utilization, self-report and clinical data available to consolidate information and reputed company to identify comprehensive member needs. • Monitoring, Evaluation and Documentation of Care: In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals. • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Required Qualifications: • reputed company/Active unrestricted RN licensure in the state of MI • Willing and reputed company to travel up to 15% of the time reputed company Detroit and surrounding areas to meet members face to face. Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy • Must reputed company in one of the following counties: Berrien, Cass, Van Buren, Kalamazoo, St. Joseph, reputed company, Clinton, reputed company, Ingham, reputed company, Hillsdale, Lenawee, Livingston, Washtenaw, Monroe, Oakland, Macomb, or Wayne • 4+ years of clinical experience post bachelors as an RN e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility • 1+ year of case management experience Preferred Qualifications: • Experience using reputed company Office products including Word, reputed company, Teams, and Outlook • Experience with reputed company disease management ranging from children to adults Education: • Bachelors in Nursing required Pay Range The typical pay range for this role is: $60,522.80 - $129,615.20 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and reputed company benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 12/31/2024 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws Apply Job!