Employment Type:

Full time

Shift:

Day Shift

Description:

Position Summary: 

Performs assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk members. Assesses and develops a care plan in collaboration with the admitting, attending and consulting physician, the member and other health care practitioners. Effectively manages members on an outpatient basis to ensure provision of an appropriate level of care, to minimize inpatient re-admissions, and to ensure that members’ medical, environmental and psychosocial needs are met across the continuum of care.

What the RN Care Manager will need:

Graduation from an accredited BSN Program

Current Michigan RN license, current CPR certification, valid Michigan Driver’s license.

Three years acute care or case management experience.

Preferred: Two years of utilization or HMO experience.

Fast paced environment, managing multiple tasks and patients at the same time while showing respect and courtesy to each individual.

Possible exposure to infectious disease, hazardous chemical, and blood and body fluid.

Ability to work flexible schedules.

What the RN Care Manager will do:

Keeps member/family members or other customers informed and requests further assistance when needed.

Demonstrates ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.

Functions as liaison between administration, members, physicians and other healthcare providers.

Interacts professionally with member/family/physicians and involves member/family/physicians in formation of the plan of care.

Performs a Health Risk Assessment (HRA) of the member and determines an acuity score for necessary scheduled follow-up.

Develops an outcome-based plan of care, based on the member’s input and assessed member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the member’s case file.

Documents member assessment and reassessment, member care plans, and other pertinent information completed in the member’s medical record in accordance with Trinity Health Alliance of Michigan charting methodology, nursing standards, and company policies and procedures.

Maintains standard workflow to meet NCQA standards alignment and manages patient caseload to meet annual contract patient care goals.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.