Case Manager

Kyyba • Detroit, MI

16h • Remote

About The Position

The Case Manager RN leads coordination of a multidisciplinary team to deliver holistic, person-centered care management to health plan members with varied health and social needs. The role serves as a point of contact for members, caregivers, and providers through phone, email, text, and the client’s online messaging platform. Using the case management process, the Case Manager assesses, develops, implements, monitors, and evaluates care plans to optimize member health across the care continuum, partnering with members, providers, and community resources to achieve care goals.

This position is fully remote. Applicants must live in a listed eligible state and hold a multistate RN license in one of the states marked “Yes.” All specialties are needed, including Pediatrics. Working hours up to 8 p.m. EST may be expected. Vacation is not allowed during the first eight weeks of training. When submitting a resume, provide proof of licenses in each state where the nurse is licensed, along with the applicant’s state of residence and time zone.

Requirements

• Nursing diploma or associate degree in nursing.
• Health plan case management experience.
• At least 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting.
• At least 1 year of case management experience in a managed care setting.
• Must live in a state listed as eligible and hold a multistate RN license in a state marked “Yes.”
• Ability to think critically, make decisions, and solve problems that may affect member outcomes.
• Empathetic, supportive, and effective listening skills.
• Intermediate computer knowledge, typing ability, and proficiency with Microsoft programs such as Excel, OneNote, Outlook, Teams, and Word.
• Proficiency in motivational interviewing.
• Demonstrated time-management skills.
• Organizational ability to manage multiple systems and tools while interacting with a member.
• Ability to work as part of a team and independently.
• Excellent written and verbal interpersonal and communication skills.

Nice To Haves

• Bachelor’s degree in nursing.
• Experience managing patients telephonically and through digital channels, including mobile applications and messaging.
• Current, active, unrestricted multistate Compact Registered Nurse license.
• Certification in Case Management (CCM).
• Certification as a Chronic Care Professional (CCP).

Responsibilities

• Lead a regionally aligned multidisciplinary team in providing holistic care to members telephonically and/or digitally.
• Use the case management process to assess, develop, implement, monitor, and evaluate care plans.
• Assess members’ health and psychosocial needs, cultural preferences, and support systems.
• Engage members and/or caregivers to develop individualized care plans, address barriers, identify gaps in care, and promote improved health outcomes.
• Arrange resources to address identified needs, including community resources, mental health and substance abuse services, financial support services, and disease-specific services.
• Coordinate care and support among members’ providers, community-based agencies, families, and other support systems.
• Advocate for members and promote self-advocacy.
• Educate members on health literacy, self-management, medication plans, and nutrition.
• Monitor care-plan effectiveness and adherence, assess progress toward goals, and adjust or reevaluate plans as needed.
• Accurately document member interactions relevant to care management.
• Prepare members and/or caregivers for discharge from a facility to home or transfer to another healthcare facility to support continuity of care.
• Educate members and/or caregivers about post-transition care and follow-up, including summarizing the care episode.
• Arrange durable medical equipment and transportation services and communicate arrangements to members, caregivers, and relevant receiving-facility or home-care personnel.
• Follow professional standards, protocols, rules, and guidelines while meeting quality and production goals.
• Complete relevant continuing education and maintain Certified Case Manager (CCM) certification.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree