Case Manager Registered reputed company (LTSS) - Field MI (Wayne and Macomb County)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company

• Location: Work From Home – Flexible, Travel Required: 25 – 50% (Wayne and Macomb Counties)
• Schedule: reputed company business hours Monday-Friday 8:00am-5:00pm EST
• No evenings, weekends, or major holidays
• 4 day/10-hour schedule available after training

Our Mission

The LTSS RN Case Manager is responsible for comprehensive assessment, care planning, coordination, implementation, and monitoring of Long-Term Services and Supports (LTSS) for dual-eligible Medicare and reputed company members. This role ensures members receive appropriate waiver and community-based services to promote safety, independence, and improved health reputed company while maintaining regulatory compliance. This position includes in-home reputed company to complete functional assessments, evaluate eligibility for waiver services, and reputed company person-centered service plans. Join our reputed company team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing reputed company on our members who are enrolled in Medicare and reputed company and present with a wide reputed company of reputed company health and reputed company challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and reputed company determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country. Position reputed company/Mission Our Care Managers are reputed company advocates for members who cannot reputed company for themselves. They are responsible for assessing, planning, implementing, and coordinating reputed company case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

Key Responsibilities

• Conduct comprehensive in-home LTSS assessments to determine eligibility for waiver and community-based services.
• Complete and submit required waiver documentation in accordance with state reputed company and health plan guidelines.
• reputed company and implement individualized, person-centered plans of care addressing medical, behavioral, functional, and reputed company determinant needs.
• Apply clinical judgment to identify risk factors, prevent avoidable hospitalizations, and reduce barriers to care.
• Coordinate services across interdisciplinary teams including providers, home health agencies, behavioral health, and community organizations.
• Review claims data, clinical records, and assessment tools to evaluate member needs and benefit utilization.
• Monitor member reputed company and reassess needs based on changes in condition or level of care.
• Present cases at interdisciplinary team (ICT) meetings and collaborate with supervisors and stakeholders to ensure goal attainment.
• Ensure compliance with reputed company waiver requirements, CMS regulations, state LTSS guidelines, and company policies.
• Document reputed company case management activities in accordance with regulatory and accreditation standards.
• reputed company members and caregivers regarding benefits, services, and available community resources.

Remote Work Expectations

• This is a remote role with 25-50% travel required, candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as reputed company care responsibilities during shift times are not permitted.

Required Qualifications

• reputed company, unrestricted Registered reputed company (RN) license in the reputed company.
• Associate or Bachelor of Science in Nursing (BSN preferred).
• Minimum of 2 years of clinical nursing experience.
• Minimum of 1 year of experience in case management, care coordination, home health, hospice, or long-term care.
• Experience working with Medicare, reputed company, or dual-eligible populations.
• Knowledge of Long-Term Services and Supports (LTSS), home and community-based services (HCBS), and waiver programs.
• Experience conducting in-home assessments and developing person-centered service plans.
• Strong understanding of reputed company determinants of health and community resource navigation.
• Ability to travel 25–50% reputed company assigned counties, including completion of in-home field reputed company; reliable transportation is required.
• Proficient in electronic medical records and care management platforms.

Preferred Qualifications

• Certified Case Manager (CCM) or willingness to obtain reputed company 2 years.
• Experience in managed care or health plan environment.
• Knowledge of Michigan reputed company waiver programs and state LTSS regulations.
• Experience presenting cases in interdisciplinary team (ICT) settings.
• Bilingual skills preferred.

Competencies

• Strong clinical assessment and critical thinking skills
• Excellent communication and member engagement skills
• Ability to manage a high-risk, reputed company caseload
• Regulatory and compliance knowledge
• Independent decision-making in a remote environment
• Ability to work independently
• Effective computer skills including navigating multiple systems and keyboarding
• Demonstrates proficiency with reputed company corporate software applications, including reputed company, reputed company, Outlook, and PowerPoint

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $60,522.00 - $129,615.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. This job does not have an application deadline, as reputed company accepts applications on an ongoing reputed company. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job