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Detroit, MI
Registered Nurse (RN)
Contract
We are looking for an RN outside of Michigan for a 100% remote Case Manager position with a health plan.
Job Description:
The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the BCBSM online messaging platform. The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member's health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.
Requirements:

• Location: Must live in an approved Nurse Licensure Compact state.
  • Colorado, Georgia, Indiana, Kentucky, Mississippi, Ohio, Pennsylvania, Virginia, Washington, Louisiana, Iowa
• Education: Nursing diploma or associate degree required; BSN preferred.
• 3 years of clinical nursing required - acute/post acute and community setting
• 1 year of managed-care case management required
  • Health plan and telephonic/digital case management experience preferred.
  • Motivational interviewing skills.
• Technology : Microsoft programs, Typing 35+ WPM, Dual Monitors, Multiple systems
• Licensure: Active, unrestricted Multistate Compact RN license required
• Certification : CCM and CCP certifications preferred.

ESSENTIAL DUTIES
1. Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors.
2. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members' health across the care continuum.
3. Assess the member's health, psychosocial needs, cultural preferences, and support systems.
4. Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes.
5. Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services).
6. Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family.
7. Advocate for members and promote self-advocacy.
8. Deliver education to include health literacy, self-management skills, medication plans, and nutrition.
9. Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary.
10. Accurately document interactions that support management of the member.
11. Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.
12. Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.
13. Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
14. Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals.
15. Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).
Why work with us? We are a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work with us you'll have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! We are an EOE, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. https://www.optechus.com/eeo_self_identification/