Community Care Manager

Role Overview: The Community Care Manager assists members appropriate for care coordination and case management program services in a community setting.

Work Arrangements:

• Remote – Associate must reside in the state of Michigan (MI); preferred counties include Wayne, Oakland, and Macomb.
• Must be able to travel to conduct home visits.

Responsibilities:

• Serves as a single point of contact for member questions and inquiries
• Conducts in-home environmental and physical assessments for high-risk members to identify unmet needs and barriers to care
• Develops and maintains individualized care plans, ensuring they are regularly reviewed and updated
• Provides disease self-management education and coaching within scope of practice
• Performs medication reviews, including reconciliation during transitions of care
• Ensures care is delivered in the least restrictive setting and supports transitions across specialties and care settings
• Connects members to community-based resources that promote independent living and help delay or prevent nursing facility placement
• Establishes and maintains collaborative relationships with community, medical, and behavioral health teams
• Works closely with and oversees Community Care Navigators to facilitate access to appropriate in-community services
• Serves as a program subject matter expert and supports the Community Care Program Manager with operational activities as needed

Education & Experience:

• Bachelor’s degree in nursing or social work required.
• Current, active, and unrestricted Registered Nurse (RN) or Licensed Master Social Worker (LMSW) in MI
• 1 year of experience conducting health assessments and delivering care in a clinical and community environment

Licensure:

• Current, active, and unrestricted Registered Nurse (RN) or Licensed Master Social Worker (LMSW)in MI
• Valid driver’s license with car insurance.

Skills & Abilities:

• Strong clinical assessment skills with the ability to evaluate member needs and identify barriers to care
• Strong communication and interpersonal skills, with the ability to engage members and collaborate with interdisciplinary teams
• Ability to educate and coach members on disease management and self-care strategies
• Critical thinking and problem-solving skills to address complex member needs and resolve care issues
• Strong organizational and time management skills
• Ability to collaborate with and provide guidance to team members
• Knowledge of healthcare regulations, accreditation standards, and compliance

• Proficiency with documentation systems, care management platforms, and Microsoft Office tools