Role Overview: The Community Care Manager assists members appropriate for care coordination and case management program services in a community setting.
Work Arrangements:
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Remote – Associate must reside in the state of Michigan (MI); preferred counties include Wayne, Oakland, and Macomb.
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Must be able to travel to conduct home visits.
Responsibilities:
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Serves as a single point of contact for member questions and inquiries
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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 scope of practice
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Performs medication reviews, including reconciliation during transitions of care
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Ensures care is delivered in the least restrictive setting and supports transitions across specialties and care settings
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Connects members to community-based resources that promote independent living and help delay or prevent nursing facility placement
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Establishes and maintains collaborative relationships with community, medical, and behavioral health teams
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Works closely with and oversees Community Care Navigators to facilitate access to appropriate in-community services
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Serves as a program subject matter expert and supports the Community Care Program Manager with operational activities as needed
Education & Experience:
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Bachelor’s degree in nursing or social work required.
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Current, active, and unrestricted Registered Nurse (RN) or Licensed Master Social Worker (LMSW) in MI
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1 year of experience conducting health assessments and delivering care in a clinical and community environment
Licensure:
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Current, active, and unrestricted Registered Nurse (RN) or Licensed Master Social Worker (LMSW)in MI
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Valid driver’s license with car insurance.
Skills & Abilities:
