Field RN Case Manager - TPA
( Learn More )
$68,000.00 - $75,000.00 /Year
2 Year Degree
2 to 4 years
Field Health Assessment RN Case Manager - Managed Long Term Care
Southfield, MI 48075
* Offers variable mix of telephonic & field Case Management, traveling to member homes & provider facilities *
*** Great for nurses who love variety and area travel (mileage reimbursed)!! ***
Your Job Summary:
As a member of the medical management team, the Nurse Case Manager plays an integral part in the coordination of care assessing the member’s condition and providing them the necessary resources, options, and coordination for a healthy care outcome. The primary responsibility of the Nurse Case Manager is to coordinate and monitor the care of Health Plan members and develop a nursing plan of care. They will participate in interdisciplinary conferences to review clinical assessments, update care plans and determine follow-up frequency. The Case Manager also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward a maximum level of independence. The focus of this position is to identify vulnerable populations and special needs members through the completion of health screens and other resources.
EXCELLENT BENEFITS AND HIGHLY COMPETITIVE SALARY OFFERED!
Valid, unrestricted state Registered Nurse (R.N.) license. BSN preferred.
At least 2-3 years’ experience in an acute care hospital.
Roughly 1-2 years’ prior experience working in a field Case Management role.
Prefer around 1-3 years prior experience at a Managed Care Organization is preferred (Health Plan, IPA, MSO, TPA, etc).
Knowledge of Federal and State assistance programs (Medicare/Medicaid/etc)
Must be comfortable seeing members in their homes, hospice, long term care (LTC) and assisted living facilities.
Computer savvy (MS Word & Excel) and typing skills are necessary.
Strong oral and written communication skills: Ability to interact within all levels of the organization and with external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
FIELD POSITION: Must be willing and able to travel throughout the assigned area (mileage reimbursed).
The Nurse Case Manager will serve the daily case management needs of members. This includes administering all provider resources through the care continuum, from the initial referral through discharge and ensuring compliance with the plan of care. They will collaborate effectively with an interdisciplinary team to establish an individualized plan of care for members. A strong emphasis is placed on Wellness, Disease Management and patient/member education to ensure compliance with the plan of care and prevention of complications with various ailments. The Case Manager will develop interventions and processes to assist the Health Plan member in meeting short and long term plan of care goals. They will coordinate member visits with providers and specialists as needed. Communication of patient needs will be conducted through timely and accurate data entry into designated care management applications. The Case Manager will participate in the development of appropriate QI processes, establishing and monitoring indicators. Utilizing their knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms, the Nurse will help guide physicians in their awareness of preferred contracts, providers, and facilities. They will coordinate the approved services with all provider staff under the specific direction of the Medical Director or Manager of Medical Management.
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