RN Case Manager

Case Management Society of America (CMSA) ®; Detroit (MI); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated RN to lead a multidisciplinary team in providing holistic care through telephonic and digital means. This role involves coordinating care, developing individualized plans, and advocating for members to optimize their health outcomes. The ideal candidate will have significant clinical experience, particularly in health plan settings, and will be passionate about improving member care. Join this innovative organization and make a meaningful impact in the lives of those you serve while advancing your professional development.

Qualifications

• 3+ years of RN experience in clinical settings.
• Experience in health plan case management and telephonic care.

Responsibilities

• Lead a multidisciplinary team to provide holistic care via telephonic means.
• Develop and monitor individualized care plans for members.

Skills

Telephonic experience

Clinical RN experience

Health plan case management

Advocacy and education skills

Care coordination

Education

Registered Nurse License

Case Management Certification (CCM)

Job description

Work remotely; must be local to Detroit, MI.

Responsibilities:

1. Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs via telephonic and/or digital means. The team includes 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 aimed at optimizing members’ health across the care continuum.
3. Assess members' health, psychosocial needs, cultural preferences, and support systems.
4. Engage members and/or caregivers to develop individualized care plans, address barriers, identify gaps in care, and promote improved health outcomes.
5. Arrange necessary resources such as community services, mental health and substance abuse services, financial support, and disease-specific services.
6. Coordinate care delivery among member support systems, including providers, community agencies, and families.
7. Advocate for members and promote self-advocacy.
8. Deliver education on health literacy, self-management, medication plans, and nutrition.
9. Monitor and evaluate the effectiveness of care management plans, assess adherence, and adjust plans as needed.
10. Document interactions accurately to support member management.
11. Prepare members and/or caregivers for discharge or transfer, ensuring continuity of care.
12. Educate about post-transition care and follow-up, summarizing care episodes.
13. Secure and communicate arrangements for durable medical equipment and transportation services.
14. Adhere to professional standards, protocols, rules, and guidelines to meet quality and productivity goals.
15. Engage in ongoing professional development, including completing relevant continuing education and maintaining CCM certification.

Minimum Requirements:

• Telephonic experience in health plan settings.
• At least 3 years of RN experience in a clinical setting.
• Experience in health plan case management.
• Experience in hospital, skilled nursing, emergency department, and ICU settings.
• Current, active, and unrestricted Michigan Registered Nurse license.
• Case Management Certification (CCM) preferred or to be obtained within 18 months of hire.