RN Case Manager
500 W. Renaissance Detroit, MI 48243
Title: RN Telephonic Case Manager
Location: Detroit, MI 48324
Hours: Monday- Friday 8: 00am -5: 00pm with opportunity to work from home
Pay: 30.00 – 32.00 hourly
Utilizing a collaborative process, the case manager will assess, plan, implement, coordinate, monitor, evaluate and advocate the options and services required to meet an individual’ s health needs, using communication and available resources to promote quality, cost effective outcomes. The case manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost effective manner in order to obtain optimum value for both the client and the reimbursement source.
Contacting the member/authorized representative on a regular basis
Advocate - The case manager will advocate on behalf of the member/authorized representative.
Conducting a thorough and objective evaluation of the patient’ s current status including physical, psychological, environmental, financial, and health status expectation.
As a patient advocate, seek authorization for case management from the recipient of services (or designer)
Assessing resource utilization and cost management; the diagnosis, past and present treatment; prognosis, goals (short and long term).
Identifying opportunities for intervention.
Assisting members in meeting and managing both health care and quality needs
Setting goals and time frames for goals appropriate to the individual.
Identifying quality of care and savings opportunities, negotiating with providers when needed, facilitating the use of appropriate extra-and-contractual benefits, and providing the member with information or links to community, state, and/or federal resources.
Maintaining communications and collaborating with patient, family, physicians and health team members and payer representatives.
Comparing the patient’ s disease course to established pathways to determine variances and then intervene as indicated.
Education and/or Experience:
- Registered Nurse with current Michigan License required
- Associates Degree in Nursing
- Bachelor’ s degree in Nursing or related fields (preferred)
- CCM certification (preferred). If not certified upon hire, encouraged to become CCM certified within four (4) years of functioning in a case management role
- 2 years full time equivalent of direct clinical care to the consumer
- 2 to 4 years of clinical experience preferably in Case Management or Home Health Care with a Medical/Surgical background
- Working knowledge of Case Management principles and procedures based on nationally recognized standards of Case Management