Role Overview: The Senior Community Care Manager supports members in community-based care coordination and case management programs while collaborating across the Medical Management department to ensure alignment with organizational initiatives and strategic goals.
Work Arrangements:
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Remote – Associate must reside in the state of Michigan (MI)
Responsibilities:
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Serves as a single point of contact for member questions in collaboration with telephonic care managers and the Community Care Management Team (CCMT)
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Conducts in-home environmental and physical assessments for high-risk members to identify unmet needs and barriers to care
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Develops and maintains individualized care plans, ensuring they are regularly reviewed and updated
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Provides disease self-management education and coaching within the scope of practice
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Performs medication reviews, including reconciliation during transitions of care
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Coordinates care across settings to ensure services are delivered in the least restrictive environment and supports transitions between care levels
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Connects members to community, medical, and behavioral health resources to address barriers and support independent living
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Collaborates with and oversees Community Care Navigators to facilitate access to in-community support services
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Serve as a subject matter expert and supports leadership with operational activities, including training, mentoring, workflow coordination, referral review, and case assignment
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Maintains a caseload and provides coverage for team members as needed to ensure continuity of care
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Acts as a clinical and operational resource to address member needs and resolve complex issues
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Ensures compliance with workflows, documentation standards, and regulatory requirements, including National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) standards
Education & Experience:
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Bachelor’s degree in nursing required.
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Current, active, and unrestricted Registered Nurse (RN) licensure in MI.
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3 plus years of case management experience.
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1 year of community care management experience.
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Home Health RN experience preferred
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Certification as a Case Manager within 2 years of hire.
Licensure:
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Current, active, and unrestricted Registered Nurse (RN) licensure in MI.
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Valid driver’s license with car insurance.
Skills & Abilities:
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Strong clinical assessment skills with the ability to evaluate member needs and identify barriers to care
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Strong communication and interpersonal skills, with the ability to engage members and collaborate with interdisciplinary teams
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Ability to educate and coach members on disease management and self-care strategies
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Critical thinking and problem-solving skills to address complex member needs and resolve care issues
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Strong organizational and time management skills
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Ability to collaborate with and provide guidance to team members
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Knowledge of healthcare regulations, accreditation standards, and compliance
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Proficiency with documentation systems, care management platforms, and Microsoft Office too
