About The Position

As an advocate for the patient, the RN care manager will assess, plan, implement, coordinate, monitor, and evaluate the options and services required to meet an individual’s health needs, using clinical and community resources to promote quality, cost effective outcomes. Integrates evidenced based clinical guidelines, preventive guidelines, and protocols, in the development of individualized care plans that are patient centric. Provides targeted interventions to avoid hospitalization and emergency room visits.

Requirements

  • RN with a valid unrestricted Michigan license
  • Three (3) years clinical nursing experience serving chronically ill patients and extensive knowledge of issues associated with chronic care and geriatrics.
  • Understanding of Population Health Management and industry trends
  • Familiar with initiatives of managed care health plans.
  • Support patient self-management goals
  • Provision of health services in a culturally competent manner
  • Problem solving and critical thinking skills
  • Ability to work in self-directed environment and with team
  • Reliable transportation, valid driver’s license, and minimum state required liability auto insurance.

Nice To Haves

  • RN, BSN
  • Three (3) years experience in a health plan or Physician Organization environment with care coordination, care management, and/or population health.
  • Telephonic care management experience
  • Home care and/or hospice experience
  • Complex Care Management course completion or CCM

Responsibilities

  • Provides telephonic and face-to-face comprehensive assessment and care management services to patients as part of an interdisciplinary team.
  • Uses multi-dimensional assessment skills, risk assessment and screening tools to target high risk and vulnerable populations.
  • Assesses over time the health care, educational, and psychosocial needs of the patient/caregiver. Uses standardized assessment tools such as depression screening, functionality, and health risk assessment.
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