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Nurse Case Manager II - Michigan

Lancesoft

Macomb, MI

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JOB DETAILS
SALARY
$44.14
LOCATION
Macomb, MI
POSTED
6 days ago
Job Id: 26-62732
Position Type: Remote
Location: Nurse Case Manager II
Est.Pay range: 44.00/hr.- 46.00/hr. W2
Schedule:Monday - Friday 8: 00 am - 5: 00 pm EST
  • Candidate MUST reside in one of these counties: Berrien, Van Buren, Cass, Kalamazoo, St. Joseph, Calhoun, Branch, Jackson, Hillsdale, Livingston, Washtenaw, Lenawee, Monroe, Oakland, Macomb, Wayne, Clinton, Eaton, or Ingham
  • Standard business hours: Monday - Friday 8: 00 am - 5: 00 pm EST. Primarily telephonic.
  • No field work needed for this role. Candidates will need a quiet, dedicated workspace with no distractions.
  • This role will require that the candidate be hard wired into the modem.
  • Candidates will need to secure a long enough ethernet cord at their own expense.
  • Must have an active and unrestricted RN license in the state of Michigan.
Position Summary
  • The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Experience:
  • 3 years clinical practice experience, e.G., hospital setting, alternative care setting such as home health or ambulatory care required.
  • Experience preferred managing chronic conditions, such as diabetes, hypertension, and asthma.
  • Experience preferred managing the CSHCS population (Children's Special Health Care Services)
  • Healthcare and/or managed care industry experience required.
  • Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
  • Effective communication skills, both verbal and written.
  • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
  • Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
  • Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
  • Typical office working environment with productivity and quality expectations.
Assessment of Members:
  • Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
  • Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
  • Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
Enhancement of Medical Appropriateness and Quality of Care:
  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
  • Using holistic approach consults with supervisors, Medical Directors, and/or other programs to overcome barriers to meeting goals and objectives;presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes
  • Identifies and escalates quality of care issues through established channels
  • Ability to speak to medical and behavioral health professionals to influence appropriate member care.
  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health
  • Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Helps member actively and knowledgably participate with their provider in healthcare decision-making
  • Analyzes all utilization, self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs.
Monitoring, Evaluation and Documentation of Care:
  • In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals
  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
  • Majority of time is spent on telephonic outreach and documentation in a clinical case management platform.
  • Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
  • Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate
Administration of benefits:
  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
  • The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
  • RN with current unrestricted MI state licensure (must have no history or infractions)
  • Case Management Certification CCM preferred
Education:
  • Requires an RN with unrestricted active license in MI
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
1.           Four options of medical Insurance
2.           Dental and Vision Insurance
3.           401k Contributions
4.           Critical Illness Insurance
5.           Voluntary Permanent Life Insurance
6.           Accident Insurance
7.           Other Employee Perks
 
About LanceSoft:
LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.
 
EEO Employer
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
 
Want to read more about LanceSoft?
Click here to visit our website - www.Lancesoft.Com

About the Company

L

Lancesoft

We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc). 

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.

COMPANY SIZE
2,000 to 2,499 employees
INDUSTRY
Staffing/Employment Agencies
FOUNDED
2000
WEBSITE
http://www.lancesoft.com/