Community Care Manager Sr

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:

• Remote – Associate must reside in the state of Michigan (MI)

Responsibilities:

• Serves as a single point of contact for member questions in collaboration with telephonic care managers and the Community Care Management Team (CCMT)
• 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 the scope of practice
• Performs medication reviews, including reconciliation during transitions of care
• Coordinates care across settings to ensure services are delivered in the least restrictive environment and supports transitions between care levels
• Connects members to community, medical, and behavioral health resources to address barriers and support independent living
• Collaborates with and oversees Community Care Navigators to facilitate access to in-community support services
• Serve as a subject matter expert and supports leadership with operational activities, including training, mentoring, workflow coordination, referral review, and case assignment
• Maintains a caseload and provides coverage for team members as needed to ensure continuity of care
• Acts as a clinical and operational resource to address member needs and resolve complex issues
• 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:

• Bachelor’s degree in nursing required.
• Current, active, and unrestricted Registered Nurse (RN) licensure in MI.
• 3 plus years of case management experience.
• 1 year of community care management experience.
• Home Health RN experience preferred
• Certification as a Case Manager within 2 years of hire.

Licensure:

• Current, active, and unrestricted Registered Nurse (RN) licensure 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 too