Care Manager, RN

Location: Kalamazoo, MI
Date Posted: 07-12-2017
Are you a Registered Nurse who dreams to be an advocate coordinating the continuum of care and enjoys high-level interactions with your patients?

Do you love to support your patients in achieving their own goals as described in their care plan and monitor adherence to treatment plans or other disease/chronic condition management programs?

Do you have a strong desire to build close relationships all members of your team and committed to working collaboratively to provide excellent care for patients?

Do you love the idea of being in a field based position in a fast-paced environment that allows you to engage our patients in the development of an integrated, patient-centered care plan that takes into account needs across the continuum of care (health, social, psycho-social)?

Are you passionate about performing effective telephonic, face to face, in-home outreach to complete necessary health and social assessments while partnering with our multi-disciplinary care team to develop interventions and changes to the care plan in response to patient’s needs and promotes positive health outcomes?


ESSENTIAL DUTIES AND RESPONSIBILITIES:
Conduct patient onboarding, including performing health risk assessments 
Crafts and develops patient care plans that addresses all problems, goals and interventions identified using appropriate mediums (e.g. historical claims data, outreach logs, completed assessments, etc.) in our care coordination record system
Identify high-risk patients (based on risk stratification criteria) who require a high frequency of care coordination and contact
Identifies caregiver training needs and tracks impact of needs and or training
Completes transition of care process in accordance with health plan guidelines; includes outreach during hospitalization, and conducting assessments upon discharge to ensure successful transition to another setting
Identify the appropriate utilization of resources
Participate in quality improvement and evaluation processes
Work closely with the Pharmacy Benefit Manager and community pharmacies to help coordinate medication accessibility and medication refills
Perform and document reassessments, revisions to care plans, and coordinate interdisciplinary care team meetings in accordance with the (health plan) model of care requirements
Conduct face to face, in-home visits with members in accordance with health plan model of care requirements
Coordinate activities with Treating Providers, Utilization Management Team, Social Services Team and Disease Management Team as needed
Complete all mandatory regulatory and other trainings required (including but not limited to: compliance training, first tier downstream and related (FWA) entity training, model of care training, etc.)
Knowledge of Healthcare Effectiveness Data Information Set (HEDIS) and engagement with members on care gap closure


QUALIFICATIONS:
Current RN License in good standing in the state of practice required
Preferred Certified Care Manager (CCM) certification or dedication to completion within 1 year of hire
Minimum of 3 years’ experience in a clinical setting
Demonstrates the ability to triage and apply critical thinking skills
Ability to communicate effectively in writing and verbally
Knowledge of Medicare and Medicaid care management requirements in accordance with CMS and MDHHS guidelines (or similar program for dual eligible beneficiaries)
Health Plan, Patient Centered Medical Home or CPC+ experience is preferred
Proficient in computer skills to include Microsoft Office Suite (Outlook, Excel, PowerPoint, Word) knowledge and ability to navigate internet based tools, and typing.
Demonstrate ability to perform multiple concurrent tasks with minimal supervision and meet compliance deadlines 

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
 
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