Job Description

**Must be located in MI and possess a c urrent, active, and unrestricted Michigan Registered Nurse license **

The Case Manager RN coordinates a multidisciplinary team to deliver holistic, person-centric care management to a diverse health plan population with various health and social needs. Serving as the single point of contact for members, caregivers, and providers, they use multiple communication channels including phone calls, emails, text messages, and the BCBSM online messaging platform. The Case Manager RN employs the case management process to assess, develop, implement, monitor, and evaluate care plans, optimizing member health across the care continuum. They collaborate with members, care providers, and community resources to develop and implement care plans and achieve stated goals.

Certificates, Licenses, Registrations:

• Current, active, and unrestricted Michigan Registered Nurse license required.
• Certification in Case Management (CCM) required or to be obtained within 18 months of hire.
• Certification in Chronic Care Professional (CCP) preferred.

Essential Duties and Responsibilities:

• Lead a multidisciplinary team, including Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff, and Medical Directors, to provide holistic care.
• Use the case management process to optimize members' health across the care continuum.
• Assess members' health, psychosocial needs, cultural preferences, and support systems.
• Engage members and caregivers to develop individualized care plans, address barriers, and promote improved health outcomes.
• Arrange necessary resources (e.g., community resources, mental health services, financial support).
• Coordinate care delivery among support systems, including providers and community-based agencies.
• Advocate for members and promote self-advocacy.
• Deliver education on health literacy, self-management skills, medication plans, and nutrition.
• Monitor and evaluate care management plans, ensuring progress towards goals and adjusting as necessary.
• Accurately document interactions to support member management.
• Prepare members and caregivers for discharge or transfer to ensure continuity of care.
• Educate on post-transition care and needed follow-up.
• Secure and communicate durable medical equipment and transportation services.
• Adhere to professional standards and meet quality and production goals.
• Continue professional development and maintain Certified Case Manager (CCM) certification.

Education and Experience:

• Nursing Diploma or Associate's degree in nursing required; Bachelor's degree in nursing strongly preferred.
• 1-3 years of clinical nursing experience in acute/post-acute care, and/or hospice/home health settings required.
• 5 year of case management experience in a managed care setting strongly preferred.
• Experience managing patients telephonically and via digital channels preferred.

Qualifications:

• Critical thinking, decisiveness, and problem-solving skills.
• Empathetic, supportive, and a good listener.
• Proficient in motivational interviewing skills.
• Demonstrated time management and organizational skills.
• Ability to manage multiple systems/tools while interacting with members.
• Intermediate computer knowledge and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word).
• Team-oriented but capable of working independently.
• Excellent interpersonal and communication skills, both written and verbal.

Job Tags

Similar Jobs