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Care Coordination Specialist

2 months ago

Lansing, Michigan, United States OpTech Full time
Job Title: Case Manager

Why work at OpTech?
OpTech is a woman-owned organization that prioritizes your insights, fosters your development, and consistently supports you. At OpTech, you will receive health and dental benefits from your first day, alongside opportunities for training, flexible work arrangements, career advancement, a 401K plan, and competitive compensation. To explore our full range of job openings, please visit our website.

RESPONSIBILITIES:
  • This role involves supporting SHS/EM/MA Fulfillment and requires a compact nursing license.
  • The Care Manager RN is responsible for leading a multidisciplinary team to implement a comprehensive, person-centered care management program for a diverse health plan population with varying health and social needs.
  • They act as the primary contact for members, caregivers, and providers through various communication methods, including phone calls, emails, text messages, and our online messaging platform.
  • The Care Manager RN utilizes the case management process to assess, create, implement, monitor, and evaluate care plans aimed at enhancing the member's health throughout the care continuum.
  • They collaborate with the member, care providers, and community resources to formulate and execute the care plan and achieve established objectives.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned:
  • Lead the coordination of a regionally aligned, multidisciplinary team to deliver holistic care that meets member needs through telephonic and/or digital means.
  • The multidisciplinary team comprises Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff, and Medical Directors.
  • Employ the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members' health across the care continuum.
  • Evaluate the member's health, psychosocial needs, cultural preferences, and support systems.
  • Engage the member and/or caregiver to create a personalized care plan, address obstacles, identify care gaps, and promote improved overall health outcomes.
  • Arrange necessary resources to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services, and disease-specific services).
  • Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family members.
  • Advocate for members and encourage self-advocacy.
  • Provide education that includes health literacy, self-management skills, medication plans, and nutrition.
  • Monitor and assess the effectiveness of the care management plan, ensuring adherence to the care plan to facilitate progress toward goals, and adjust and reevaluate as necessary.
  • Accurately document interactions that support the management of the member.
  • Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to ensure continuity of care.
  • Educate the member and/or caregiver about post-transition care and necessary follow-up, summarizing the events during an episode of care.
  • Secure durable medical equipment and transportation services, communicating this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
  • Adhere to professional standards as outlined by protocols, rules, and guidelines, meeting quality and production goals.
  • Pursue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM) status.
QUALIFICATIONS:
  • To perform this job successfully, an individual must be able to execute each essential duty satisfactorily.
  • The requirements listed below are representative of the knowledge, skill, and/or ability required.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
OTHER SKILLS AND ABILITIES:
  • Ability to think critically, make decisions, and solve problems on various topics that can impact a member's outcomes.
  • Empathetic, supportive, and a good listener.
  • Proficient in motivational interviewing techniques.
  • Demonstrated time management capabilities.
  • Organizational skills with the ability to manage multiple systems/tools while simultaneously interacting with a member.
  • Must possess intermediate computer knowledge, typing skills, and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).
  • Must embrace teamwork but also be capable of working independently.
  • Excellent interpersonal and communication skills, both written and verbal.
EDUCATION AND EXPERIENCE:
  • Nursing Diploma or Associate's degree in nursing required.
  • Bachelor's degree in nursing strongly preferred.
  • 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required.
  • 1 year of case management experience in a managed care setting strongly preferred.
  • Experience managing patients through telephonic and digital channels (mobile applications and messaging) preferred.
CERTIFICATES, LICENSES, REGISTRATIONS:
  • This position supports SHS/EM/MA Fulfillment and requires a compact nursing license.
  • Current, active, and unrestricted Michigan Registered Nurse license required.
  • Certification in Case Management (CCM) required or to be obtained within 18 months of hire.
  • Certification in Chronic Care Professional (CCP) preferred.
OpTech is an equal opportunity employer and is committed to fostering a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state, or local laws.

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