Case Manager Registered Nurse (Wayne and Macomb Counties)

Hispanic Alliance for Career Enhancement; Lansing (MI); Remote; USD 60,000 - 90,000; Full time

Job summary

A leading health solutions company is seeking a Case Management Manager to enhance patient care for dual eligible populations. This full-time telework role involves assessing and coordinating care, applying clinical judgment, and collaborating with community organizations. Join a passionate team dedicated to improving health outcomes for members facing complex challenges.

Qualifications

• Experience in case management or similar role.
• Ability to assess and coordinate care effectively.
• Strong communication skills for member engagement.

Responsibilities

• Assessing, planning, implementing, and coordinating case management activities.
• Developing proactive care plans to improve member outcomes.
• Collaborating with interdisciplinary teams to address member needs.

Skills

Clinical judgment

Communication

Motivational interviewing

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues — caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Requisition Job Description

This is a full-time telework role involving up to 25% - 50% travel in Wayne and Macomb County, MI.

Schedule: Standard business hours - 8:00AM-5:00PM, no night, weekend, or holiday shifts!

There is potential of moving to a four day / ten hour shift schedule after a 6 month probationary period.

Help us elevate our patient care to a whole new level!

Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have a life-changing impact on our members enrolled in Medicare and Medicaid with complex health and social challenges. Through compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of health care and social needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives across the country.

Position Summary/Mission

Our managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate medical needs and facilitate overall wellness.

Develops a proactive care plan to address issues, aiming to improve short- and long-term outcomes and overall wellness.

• Uses clinical tools and data review to evaluate member needs and benefits.
• Applies clinical judgment to reduce risk factors and barriers, addressing complex health and social indicators impacting care planning.
• Conducts comprehensive assessments considering multiple sources, including claims, to address all conditions affecting functionality.
• Uses a holistic approach to determine referral needs to clinical resources and interdisciplinary team members.
• Collaborates with supervisors and stakeholders, presents cases at interdisciplinary conferences.
• Follows case management processes in compliance with regulations and policies.
• Uses motivational interviewing to maximize member engagement and accurately assess health status and needs.