RN or SW MSW Health Plan Care Manager

Priority Health; Netherlands; On-site; EUR 60,000 - 86,000; Full time

Benefits offered by this job

On-demand pay

Discounts directory

Identity theft protection

Retirement options

Job summary

Corewell Health seeks an experienced care manager to plan and prioritize care for individuals and populations, including in-home and community visits and telephonic work. You will collaborate with providers and community resources to promote health and wellbeing and address access barriers.

The role emphasizes care coordination, documentation, and coordinating services across the continuum with a focus on outcomes and cost-effectiveness. Requires RN or MSW with relevant managed care experience.

Qualifications

• Bachelor's degree or equivalent in nursing or social work.
• 5 years of relevant experience in case management or managed care.
• MSW or RN preferred at hire; CCM credential preferred.

Responsibilities

• Develop and prioritize care plans to meet member needs in managed care.
• Coordinate with providers and community resources to improve access and outcomes.
• Assess referrals and plan care across the continuum of care.
• Document data, plans, interventions and outcomes per guidelines.
• Participate in interdisciplinary care management teams for in-home and community visits.
• Ensure quality, cost-effectiveness and continuous improvement of services.

Skills

Collaboration

Care coordination

Communication skills

Data interpretation

Education

Bachelor's Degree or equivalent Nursing

Master's Degree Social work

Master Social Worker (MSW)

Registered Nurse (RN)

Case Manager, Certified (CCM)

Job description

Home visits in the counties of Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, VanBuren

Scope of work

Plans and prioritizes care for individuals and population of patients, focusing on strategies that will promote optimal health within populations. Demonstrates expertise, current knowledge in care and management of a caseload of members of varying complexity and seeks to improve member, family, and health systems / community outcomes through the application of educational concepts / skills and preventive care in a managed care environment. Collaborate with providers, community organizations, and systems to coordinate care and ensure members and their families are connected to the resources needed to promote health and wellbeing, and advocate and address any barriers to access needed services. This position includes in-home, community-based work, as well as telephonic work.

• Develops and prioritizes plans to meet needs and provides services. Follow up with families and community agencies to evaluate the effectiveness of services provided and plan for future needs. Works as part of an interdisciplinary care management team conducting in home/in community visits.
• Develops plan of care and makes recommendations to PCPs, specialists and other members of the health care team regarding care management strategies, identifying strategies to maximize continuity of care across the continuum.
• Assess internal and external referrals to meet identified member and their family's needs, level of intensity, mandated reporting referrals, insurance benefits, and other member resources.
• Communicates and collaborates with member/significant others/providers/payers to coordinate services that improve access to appropriate services across the continuum of care and which promotes optimal health in a cost-effective manner.
• Measure member care outcomes, interprets reports, and analyzes data trends for groups of members.
• Documents member data, plan, interventions and outcomes according to department guidelines.
• Ensures processes and services are continuously monitored for quality, cost effectiveness, and efficiency, Engages in process and quality improvement activities. Makes and implements recommendations to improve operational efficiency and to implement new services for areas of responsibility,
• Assesses the educational needs of members, families and members of the health care team and develops and implements appropriate teaching strategies or makes referrals. Maintains knowledge of current trends and developments in the field

Qualifications

• Required Bachelor's Degree or equivalent Nursing, or
• Required Master's Degree Social work
• 5 years of relevant experience LLMSW, LMSW, RN - clinical and/or case management/managed care or related field OR Clinical Nursing and /or case management/managed care or related field Required
• Master Social Worker (MSW-Master) - State of Michigan Upon Hire required Or
• Registered Nurse (RN) - State of Michigan Upon Hire required
• Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - 240 E 8th Street

Department Name

Care Management DSNP - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

40

Days Worked

Monday to Friday

Weekend Frequency

N/A

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.