Remote Utilization Management Jobs in Michigan (NOW HIRING)

Summary
**Hybrid Position - Opportunity for onsite and remote work**
A patient care navigator renders assistance to patients and professional staff, within an assigned department or centralized geography, in support of improving care access, care transitions and coordination of patient care resources. This role works collaboratively with interdisciplinary team members who manage medically or socially complex patient panels. The patient care navigator will actively engage with patients and caregivers both in the practice/clinic and over the phone using critical thinking and communication skills to identify barriers that may be impacting the patients ability to achieve optimal health. Patient health care navigators facilitate timely access to medical care, and link patients, families to professional and community resources to enable patients to become active participants in managing their own care.
The patient care navigator provides additional support/education and navigation to both clinical and community resources for patients recently discharged from the hospital and emergency department. This role may meet with patients at locations outside of the MyMichigan Health campus, including the patient's home or a community location.
They may also assist with coordinating patient appointments, medical prior authorizations, and conducting patient outreach post discharge and/or for patients who are challenged with meeting patient appointments. Patient care navigator will work collaboratively with the care manager to optimize clinical efficiency.
Responsibilities
(60%)* Utilizes motivational interviewing techniques to identify social risk factors that may be hindering patients from meeting their health care goals. Completes required clinical screenings to assist with identification of patient's risk factors. Links patients to the community and medical resources needed to address social determinants of care and/or barriers to health care goals. Coordinates medical appointments, assists patients in addressing their barriers to medication regimen adherence, actively works with patients to increase adherence to scheduled appointments, and coordinates follow up with non-clinical services such as transportation, home health, homeless shelters, home meal delivery, etc. Maintain appropriate documentation of patient contact, referrals made and services provided.
(20%)* Effectively and professionally, completes the appropriate work flow & documentation for all assigned patients. Communicates all urgent concerns regarding patient care needs to appropriate care team members in a timely manner.
(15%)* Educates patients on appropriate utilization of healthcare resources. Contributes to the development and management of the patient care plan by actively collaborating with care manager, provider and other team members based on patient interactions.
(5%)* Participates in process improvement projects and specific clinical tasks as assigned to improve patient access.
OTHER DUTIES AND RESPONSIBILITIES:
The patient care navigator role will contact patients recently discharged from the medical center or emergency department to (inpatient/ED) follow up, patients with significant no show rates to identify any barriers related to patients reaching their goals.
Assist patients who require clearance (authorization) prior to scheduling appointments.
Assist patients who require specialty care through directly booking appointments where authorized or through working with individual specialty departments to schedule appointments.
Assist patients with education on obtaining community resources to remove their barriers for health care.
Contacts patients who have missed two medical appointments in order to facilitate future compliance.
Works with patients to understand their challenges with attending patient visits and assist them with securing and meeting a plan to overcome their obstacles.
Effective customer service and communication skills required.
Provides education to patients for health care and community resources.
Demonstrate clinical competencies on an annual basis.
Certifications and Licensures
BLS - Basic Life Support Required Within 3 months of hire or transfer
MA CERT - Medical Assistant Required
As required by Medicare and Medicaid Services (CMS) to be employed through MyMichigan Health all Medical Assistants must possess one of the following active certification/licensure:

• Registered Medical Assistant (RMA) through American Medical Technologist (AMT)
• Certified Medical Assistant (CMA) through American Association of Medical Assistants (AAMA)
• OR equivalent Medical Assistant Credential such as (Certified Clinical Medical Assistant CCMA, etc.). Prefer completion of a Medical Assistant program through an accredited organization.
• Medical First Responder, Emergency Medical Tech Basic/Specialist, or Paramedic though the State of Michigan. Registered Radiologic Technologist through American Registry of Radiologic Technologists (ARRT)

Required Education
Education: High School Diploma or GED
Other Information
EXPERIENCE, TRAINING AND SKILLS:
Assists in maintaining a clean and safe environment for patients and co-workers.
If applicable, maybe required to travel to satellite clinics and travel to patient's home or to community resources.
Maintains a high level of confidentiality and ensures patient's rights in accordance with proper procedures and in compliance with HIPAA (Health Insurance Portability Accountability Act).
May assist with completing tasks to address the patient's health care plan, which to overcome barriers such as completing forms, corresponding with community organizations and/or other medical care providers.
Follows all MyMichigan Health policies and adheres to the current Electronic Medical Record (EMR) workflows to ensure documentation is able to be easily accessed by other team members and reportable for quality initiatives.
Provides for the age specific needs of the population served according to department standards and policies/procedures as evidenced by observation, documentation and peer feedback.
Ability to be empathetic and resourceful to all patients regardless of their social and/or medical complexities.
Multi-tasking skills and ability to facilitate messages, complaints, and urgent calls as appropriate.
Ability to work collaboratively with internal/external health care team members and navigate through the health care system.
Navigators must be able to thrive in a moderately paced, urgent need, complex health care environment where the incumbent works as a key, valued member of the multidisciplinary team.
Ability to carry out written and verbal instructions.
Ability to review reports and interpret information for prioritization of duties.
Ability to exercise judgement in the application of professional services.
Ability to communicate effectively and serve as a contact person for community partners who have questions about the continuity of care process or need assistance/trouble shooting for their referred patients.
Practices within the scope of the medical certification.
Performs other related duties as assigned.
MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft® Windows. An employee may be required to participate in further learning opportunities offered by MyMichigan Health.
PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:
Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
Overall vision and hearing is necessary with or without assisted device(s).
Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.
Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.
Physical Demand Level: Light. Must be able to occasionally (0-33% of the workday) lift or carry 11-20 lbs., frequently (34-66% of the workday) 10 lbs. and or Walk/Stand/Push/Pull of Arm/Leg controls.
Other Comments