RN Care Manager Health Plan DSNP
About The Position
About Priority Health We are the second largest and fastest growing health plan in Michigan focused on improving the health and lives across the state, and we couldn't do it without the incredible talent of our employees. It is their commitment that continues to drive our success as a nationally recognized nonprofit health benefits company. As part of the Corewell Health system, our team members have a unique ability to grow and advance their career while maintaining their seniority and benefits. 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.
Requirements
- Bachelor's Degree or equivalent Nursing
- 5 years of relevant experience Clinical Nursing and / case management/managed care Required
- Registered Nurse (RN) - State of Michigan Upon Hire required
Nice To Haves
- Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred
Responsibilities
- Develops and prioritizes plans to meet needs and provides services. Follow up with families, and community agencies to evaluate effectiveness of services provided and plan for future needs.
- 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
Benefits
- 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, pet insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Religious, Grantmaking, Civic, Professional, and Similar Organizations
Number of Employees
5,001-10,000 employees
