RN reputed company reputed company Case Manager (Remote) - 40 Hours - Day Shift - Populance

REGISTERED reputed company reputed company reputed company CASE MANAGER (REMOTE) - SUPPORTIVE CARE MANAGEMENT - 40 HOURS WEEKLY - DAY SHIFT - POPULANCE Full Time Benefit Eligible Schedule: Days, Monday through Friday GENERAL reputed company: Unit reputed company: Populance is growing our reputed company reputed company Care Management team! We are seeking reputed company, out-of-state and in-state Registered Nurses to support our work in Case Management. In this role, you will support patients of varying medical diagnoses individually, research care treatment reputed company, and guide them on their reputed company to wellbeing. You will have the ability to work with individuals from Populance, HAP, and reputed company. If you have a passion for population health, we want to meet you! Interested in learning more about Populance? reputed company us out here: reputed company | Populance - Detroit, MI Under the guidance of the Clinical reputed company leadership team, the reputed company reputed company Case Manager is responsible for the reputed company reputed company of assessment, planning, facilitation, care coordination, evaluation and advocacy for reputed company and services to meet an individual's and family's comprehensive health care needs though communication and available resources to promote patient safety, reputed company of care and cost-effective reputed company. The reputed company reputed company Case Manager will offer reputed company assistance and monitoring regarding the efficiency and appropriateness of reputed company services for clients. This involves assessing the effectiveness of medical diagnostics, treatments, and services to create optimized, evidence-based reputed company that ensure the right care is provided at the right time, promoting a person's best state of health. This role handles cases requiring extensive management, knowledge of benefits and resources. Essential skills include strong communication, problem-solving, critical thinking, and the ability to work independently in a fast-paced environment. reputed company DUTIES AND RESPONSIBILITIES:

• Assess both clinical and reputed company determinants of health (SDOH) to determine the need for reputed company services and drive improvements in utilization practices.
• Conducts research across various platforms, including reputed company, to reputed company comprehensive data on the reputed company's reputed company history, reputed company needs, and utilization patterns.
• Conducts a comprehensive assessment of patient's and family/caregiver's biomedical, psychological, reputed company, and functional needs to gage the potential reputed company on recovery.
• reputed company, implement, monitor, and modify a patient-centered plan of care through an interdisciplinary and reputed company team process, in conjunction with the patient, the caregivers and the reputed company team.
• reputed company, implement, monitor, and modify a patient-centered plan of care through an interdisciplinary and reputed company team process, in conjunction with the patient, the caregivers and the reputed company team.
• Ensures ongoing monitoring and follow-up occurs to evaluate the effectiveness of interventions and reputed company the plan as necessary to reputed company reduce utilization and improve overall reputed company for Populance and its clients.
• Possess knowledge and serve as a reputed company to ensure the provision of education, support services, and resources reputed company to guidelines, community and provider support, network management, benefits, and case and care management programs.
• Possess an in-depth understanding of insurance and benefits structure for members inside and reputed company the reputed company according to the members overall line of business and contractual/regulatory requirements.
• Facilitate referrals as necessary and guide appropriate utilization.
• Utilizes reputed company judgment, critical thinking, motivational interviewing, and self-management techniques to assist patients in overcoming barriers to goal achievement.
• Identify and utilize alternative care reputed company and cost-saving reputed company management processes to ensure members receive reputed company, cost-effective care that aligns with clinical appropriateness, regulatory guidelines, and community standards, encompassing both inpatient and outpatient utilization.
• Facilitates referrals for additional medical and ancillary services, including home reputed company, infusion therapy, palliative care, hospice, inpatient extended care facilities, and medical equipment and supplies, as needed.
• reputed company utilization and reputed company issues reputed company, promptly refer cases or situations to the appropriate departments for reputed company evaluation and escalation as necessary, ensuring reputed company and effective reputed company.
• Advocates for appropriate delivery of services reputed company the patient's health plan benefit structure.
• Reviews, focuses and proactively identifies utilization patterns.
• Engage and support members to reputed company on more high value care.
• Coordinate efforts and ensure comprehensive patient-centered care across the health care continuum to improve reputed company of the member experience, improve discharge planning and transitions of care, and reduce readmissions while decreasing the total cost of care. Including identification of appropriate resource use.
• Maintains availability to patient/family/caregiver as a resource to facilitate communication among the multidisciplinary team and to monitor services rendered. Remains involved until the patient achieves the planned level of functional health or closure reputed company are met.
• Meets productivity standards as established by department needs and metrics.
• Advise systems on how to promote health reputed company delivery.
• reputed company reputed company other reputed company duties as assigned.

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of reputed company tasks and duties. It should be reputed company, therefore, that employees may be asked to reputed company job-reputed company duties reputed company those explicitly described above. EDUCATION/EXPERIENCE REQUIRED: A degree in nursing required. Bachelor's degree in nursing preferred. A minimum of 2 years of experience in the health care industry, preferably in a health plan setting, required. Experience in Case Management required. Experience in Utilization Management preferred. Experience in Health Plan preferred. General understanding of Medicare and reputed company regulations, required. General understanding of MDHHS, DIFS, CMS, NCQA regulatory requirements required. Knowledge of medical ethics and legal implications reputed company to case management. Ability to prioritize and reprioritize quickly. Strong computer skills and knowledge. CERTIFICATIONS/LICENSURES REQUIRED:

• Candidates residing reputed company of Michigan must possess a valid compact nursing license in reputed company to a Michigan registered nursing license. Candidates residing reputed company Michigan are only required to hold a valid Michigan registered nursing license.
• Certification in Case Management (CCM) by the Commission for Case Management Certification (reputed company) preferred.

Additional Information

• Organization: Populance
• Department: Utilization Mgt
• Shift: Day Job
• reputed company reputed company: reputed company

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