RN Client Focused Case Manager (Remote) - 40 Hours - Day Shift - Populance id-6192
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<p><strong>REGISTERED NURSE CLIENT FOCUSED CASE MANAGER (REMOTE) - SUPPORTIVE CARE MANAGEMENT - 40 HOURS WEEKLY - DAY SHIFT - POPULANCE </strong>Full Time Benefit Eligible<br />
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Schedule: Days, Monday through Friday<br />
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<strong>General Summary</strong><br />
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<strong>Unit Description: </strong><br />
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Populance is growing our Client Focused Care Management team! We are seeking experienced, out-of-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 pathways, and guide them on their journey to wellbeing. You will have the ability to work with individuals from Populance, HAP, and Henry Ford Health. If you have a passion for population health, we want to meet you!<br />
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Interested in learning more about Populance? Check us out here: About Us | Populance - Detroit, MI<br />
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Under the guidance of the Clinical Success leadership team, the Client Focused Case Manager is responsible for the collaborative practice of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health care needs though communication and available resources to promote patient safety, quality of care and cost-effective outcomes. The Client Focused Case Manager will offer continuous assistance and monitoring regarding the efficiency and appropriateness of healthcare services for clients. This involves assessing the effectiveness of medical diagnostics, treatments, and services to create optimized, evidence-based pathways that ensure the right care is provided at the right time, promoting a person’s best state of health.<br />
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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.<br />
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Dependent on volume, the Client Focused Case Management Nurse may also be responsible for handling case management requests within the state of Michigan.<br />
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<strong>Principle Duties And Responsibilities</strong></p>
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<li>Assess both clinical and social determinants of health (SDOH) to determine the need for healthcare services and drive improvements in utilization practices.</li>
<li>Conducts research across various platforms, including Epic, to gather comprehensive data on the client’s healthcare history, current needs, and utilization patterns.</li>
<li>Conducts a comprehensive assessment of patient’s and family/caregiver’s biomedical, psychological, social, and functional needs to gage the potential impact on recovery.</li>
<li>Develop, implement, monitor, and modify a patient-centered plan of care through an interdisciplinary and collaborative team process, in conjunction with the patient, the caregivers and the healthcare team.</li>
<li>Develop, implement, monitor, and modify a patient-centered plan of care through an interdisciplinary and collaborative team process, in conjunction with the patient, the caregivers and the healthcare team.</li>
<li>Ensures ongoing monitoring and follow-up occurs to evaluate the effectiveness of interventions and adjust the plan as necessary to further reduce utilization and improve overall outcomes for Populance and its clients.</li>
<li>Possess knowledge and serve as a liaison to ensure the provision of education, support services, and resources related to guidelines, community and provider support, network management, benefits, and case and care management programs.</li>
<li>Possess an in-depth understanding of insurance and benefits structure for members inside and outside the state of Michigan according to the members overall line of business and contractual/regulatory requirements.</li>
<li>Facilitate referrals as necessary and guide appropriate utilization.</li>
<li>Utilizes professional judgment, critical thinking, motivational interviewing, and self-management techniques to assist patients in overcoming barriers to goal achievement.</li>
<li>Identify and utilize alternative care options and cost-saving quality management processes to ensure members receive quality, cost-effective care that aligns with clinical appropriateness, regulatory guidelines, and community standards, encompassing both inpatient and outpatient utilization.</li>
<li>Facilitates referrals for additional medical and ancillary services, including home healthcare, infusion therapy, palliative care, hospice, inpatient extended care facilities, and medical equipment and supplies, as needed.</li>
<li>When utilization and quality issues arise, promptly refer cases or situations to the appropriate departments for further evaluation and escalation as necessary, ensuring timely and effective resolution.</li>
<li>Advocates for appropriate delivery of services within the patient’s health plan benefit structure.</li>
<li>Reviews, focuses and proactively identifies utilization patterns.</li>
<li>Engage and support members to focus on more high value care.</li>
<li>Coordinate efforts and ensure comprehensive patient-centered care across the health care continuum to improve quality 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.</li>
<li>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 criteria are met.</li>
<li>Meets productivity standards as established by department needs and metrics.</li>
<li>Advise systems on how to promote health focused delivery.</li>
<li>Perform all other related duties as assigned.<br />
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<p><em>This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.</em><br />
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<strong>Education/Experience Required</strong></p>
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<li>A degree in nursing required.</li>
<li>Bachelor’s degree in nursing preferred.</li>
<li>A minimum of 2 years of experience in the health care industry, preferably in a health plan setting, required.</li>
<li>Experience in Case Management required.</li>
<li>Experience in Utilization Management preferred.</li>
<li>Experience in Health Plan preferred.</li>
<li>General understanding of Medicare and Medicaid regulations, required.</li>
<li>General understanding of MDHHS, DIFS, CMS, NCQA regulatory requirements required.</li>
<li>Knowledge of medical ethics and legal implications related to case management.</li>
<li>Ability to prioritize and reprioritize quickly.</li>
<li>Strong computer skills and knowledge.<br />
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<p><strong>Certifications/Licensures Required</strong></p>
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<li>Registered Nurse (RN) with a valid, unrestricted State of Michigan license, AND Registered Nurse (RN) with a valid, unrestricted Muti-State Licensure. RN must reside in a state that is part of the Nurse Compact state licensure.</li>
<li>Certification in Case Management (CCM) by the Commission for Case Management Certification (CCMC) preferred.<br />
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<p>Additional Information</p>
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<li>Organization: Populance</li>
<li>Department: Utilization Mgt</li>
<li>Henry Ford Health Location: Healthy Populations</li>
<li>Shift: Day Job</li>
<li>Union Code: Not Applicable</li>
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