RN Care Manager-Care Management

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

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Competitive Total Compensation Package

Overview: The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person-centric care management program to a diverse health plan population with a variety of health and social needs.&nbsp; They serve as the single point of contact for members and their families using a variety of digital channels to meet members where they are. The Care Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member&rsquo;s health across the care continuum. They work in partnership with the member, providers of care, and community resources to develop and implement the plan of care and achieve stated goals.
Responsibilities: <ul> <li>Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs. This team will work with internal and external partners to maximize impact.</li> <li>Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members&rsquo; health across the care continuum.</li> <li>Assess the member's health and psychosocial needs and support systems and consider their cultural preferences.</li> <li>Engage the member and/or caregiver to develop an individualized plan of care.&nbsp;</li> <li>Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services).</li> <li>Coordinate care delivery and support among member support systems, including providers, community-based agencies, and families.</li> <li>Deliver education to include health literacy, self-management skills, medication plans, nutrition, weight management, etc.</li> <li>Monitor and evaluate the effectiveness of the care management plan and change as necessary.</li> <li>Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.&nbsp; Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.</li> <li>Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.</li> <li>Assess adherence to care plan and report feedback to necessary stakeholders (e.g., PCPs, caregivers).</li> <li>Measure and document results of the care plan toward meeting members&rsquo; goals.</li> <li>Adhere to professional standards as outlined by protocols, rules, and guidelines meeting quality and production goals.</li> <li>Continue professional development by completing relevant continuing education and maintaining CMC (Case Manager Certification).</li> </ul>
Requirements: <p><u>EDUCATION AND/OR EXPERIENCE</u></p> <ul> <li>Nursing Diploma or Associates degree in nursing required</li> <li>Bachelor&rsquo;s degree in nursing preferred</li> <li>2 years of clinical nursing experience in clinical, acute care, or community setting required</li> <li>1 year of case management experience in a managed care setting strongly preferred</li> <li>Experience managing patients telephonically preferred</li> </ul> <p><u>CERTIFICATES, LICENSES, REGISTRATIONS</u></p> <ul> <li>Current, active, and unrestricted Michigan Registered Nurse license required</li> <li>Certification in Case Management (CCM) preferred or to be obtained within 12 months of hire</li> <li>Certification in Chronic Care Professional (CCP) preferred</li> </ul> <p><u>OTHER SKILLS AND ABILITIES</u></p> <ul> <li>Be a critical thinker with the ability to think outside the box on a large variety of topics</li> <li>Strong decision making and problem-solving skills</li> <li>Empathetic, supportive, and a good listener</li> <li>Proficient in motivational interviewing</li> <li>Demonstrated time management skills</li> <li>Ability to multi-task, while still being thorough when dealing with members</li> <li>Must have intermediate computer knowledge, typing capability, and proficiency in Microsoft Word and Outlook</li> <li>Must embrace teamwork, but enjoy working independently</li> <li>Excellent interpersonal and communication skills both written and verbal</li> </ul>