RN or SW MSW Health Plan Care Manager

spectrumhealth; Holland (MI); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits

On-demand pay

Discounts directory

Identity theft protection

Retirement options

Job summary

Corewell Health is seeking a full-time Care Manager to plan and prioritize care for individuals and populations across in-home, community-based, and telephonic settings.

You will collaborate with providers and community organizations to coordinate services, develop plans of care, and monitor outcomes for diverse patient families in Michigan. A nursing or social work background with relevant experience and Michigan licensure upon hire is required.

Qualifications

• Bachelor's degree required or equivalent in Nursing or related field.
• Master’s degree in Social Work required.
• 5 years of relevant experience in care management or managed care.
• MSW or RN required upon hire in Michigan.
• CCM certification preferred.

Responsibilities

• Plan and prioritizes care for individuals and populations to promote optimal health.
• Collaborate with providers and community organizations to coordinate care.
• Conduct in-home, community-based, and telephonic visits.
• Develop care plans and coordinate referrals to PCPs and specialists.
• Monitor outcomes, document data, and ensure quality and cost-effectiveness.

Education

Bachelor's Degree or equivalent Nursing

Master’s Degree Social Work

MSW (Michigan Upon Hire)

RN (Michigan Upon Hire)

CCM Certification (preferred)

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.

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