RN Client Focused Case Manager (Remote) - 40 Hours - Day Shift - Populance

Henry Ford Health System; Detroit (MI); Remote; USD 60,000 - 95,000; Full time

Job summary

Ein innovatives Unternehmen im Gesundheitswesen sucht einen engagierten Registered Nurse Client Focused Case Manager, um Patienten auf ihrem Weg zur Gesundheit zu unterstützen. In dieser spannenden Rolle haben Sie die Möglichkeit, mit einem dynamischen Team zusammenzuarbeiten und Patienten individuell zu betreuen. Sie werden umfassende Bewertungen durchführen, Pflegepläne entwickeln und wertvolle Ressourcen bereitstellen, um die Qualität der Versorgung zu verbessern. Wenn Sie eine Leidenschaft für die Gesundheitsversorgung haben und einen positiven Einfluss auf das Leben der Menschen ausüben möchten, ist diese Position genau das Richtige für Sie.

Qualifications

• Abschluss in Pflege erforderlich; Bachelor bevorzugt.
• Mindestens 2 Jahre Erfahrung im Gesundheitswesen, vorzugsweise im Gesundheitsplan.

Responsibilities

• Bewertung klinischer und sozialer Gesundheitsdeterminanten zur Bestimmung der Gesundheitsbedürfnisse.
• Entwicklung und Umsetzung patientenzentrierter Pflegepläne in Zusammenarbeit mit dem Gesundheitsteam.

Skills

Kommunikation

Problem-Lösungskompetenz

Kritisches Denken

Selbstmanagement-Techniken

Education

Bachelor in Nursing

2 Jahre Erfahrung im Gesundheitswesen

Tools

Epic

Job description

RN Client Focused Case Manager (Remote) - 40 Hours - Day Shift - Populance

REGISTERED NURSE CLIENT FOCUSED CASE MANAGER (REMOTE) - SUPPORTIVE CARE MANAGEMENT - 40 HOURS WEEKLY - DAY SHIFT - POPULANCE

Schedule: Days, Monday through Friday

GENERAL SUMMARY:

Unit Description:

Populance is growing our Client Focused Care Management team! We are seeking experienced, out-of-state Registered Nurses to support our work in Case Management. In this role, you will support patients of varying medical diagnoses individually, research care treatment pathways, and guide them on their journey to wellbeing. You will have the ability to work with individuals from Populance, HAP, and Henry Ford Health. If you have a passion for population health, we want to meet you!

Under the guidance of the Clinical Success leadership team, the Client Focused Case Manager is responsible for assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet individual and family healthcare needs. This involves communication and use of available resources to promote patient safety, quality of care, and cost-effective outcomes. The Case Manager will offer continuous assistance and monitoring regarding the efficiency and appropriateness of healthcare services, assessing the effectiveness of diagnostics, treatments, and services to create optimized, evidence-based pathways that ensure the right care at the right time, promoting the patient's best health.

This role handles cases requiring extensive management, knowledge of benefits and resources. Essential skills include strong communication, problem-solving, critical thinking, and the ability to work independently in a fast-paced environment.

Dependent on volume, the Case Manager may also handle requests within Michigan.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

1. Assess clinical and social determinants of health (SDOH) to determine healthcare needs and improve utilization practices.
2. Conduct research across platforms, including Epic, to gather comprehensive data on healthcare history, current needs, and utilization patterns.
3. Perform comprehensive assessments of patients and families to gauge impact on recovery.
4. Develop, implement, monitor, and modify patient-centered care plans collaboratively with the healthcare team and patient.
5. Ensure ongoing monitoring and follow-up to evaluate interventions and adjust plans to reduce utilization and improve outcomes.
6. Serve as a liaison to provide education, support services, and resources related to guidelines, community and provider support, benefits, and programs.
7. Understand insurance and benefits structures for members in and outside Michigan, according to the line of business and regulatory requirements.
8. Facilitate referrals and guide appropriate utilization.
9. Utilize professional judgment, critical thinking, motivational interviewing, and self-management techniques to help patients overcome barriers.
10. Identify alternative care options and cost-saving processes to ensure quality, cost-effective care aligning with clinical and regulatory standards.
11. Facilitate referrals for additional services, including home healthcare, infusion therapy, palliative care, hospice, and medical equipment.
12. Refer cases with utilization or quality issues to appropriate departments for evaluation and escalation.
13. Advocate for services within the patient's health plan benefits.
14. Review utilization patterns and promote high-value care.
15. Coordinate patient-centered care across the healthcare continuum to improve quality, discharge planning, transitions, and reduce readmissions and costs.
16. Remain available to patients and families as a resource, monitoring services until goals are met.
17. Meet productivity standards as established.
18. Advise on health-focused delivery improvements.
19. Perform all other duties as assigned.

This job description is not exhaustive; employees may perform additional duties as needed.

EDUCATION/EXPERIENCE REQUIRED:

• Degree in nursing required; Bachelor's preferred.
• Minimum 2 years in healthcare, preferably in a health plan setting.
• Experience in Case Management required; Utilization Management preferred.
• Knowledge of Medicare, Medicaid, MDHHS, DIFS, CMS, NCQA regulations.
• Strong computer skills and ability to prioritize quickly.

CERTIFICATIONS/LICENSURES REQUIRED:

• Active, unrestricted RN license in Michigan and Multi-State Licensure under Nurse Compact.
• Certification in Case Management (CCM) preferred.