REGISTERED NURSE CLIENT FOCUSED CASE MANAGER (REMOTE) – UTILIZATION MANAGEMENT – 40 HOURS WEEKLY – DAY SHIFT – POPULANCE
Full Time Benefit Eligible
Schedule: Days, Monday through Friday, Varying start times between 8:00 AM and 9:00 AM EST
GENERAL SUMMARY:
Unit Description:
Populance is growing our Utilization Management Team! We are seeking experienced, out-of-state Registered Nurses to support our work in Case Management. In this role, you will support patients of varying medical diagnoses individually, research care treatment pathways, and guide them on their journey to wellbeing. You will join our existing Palliative Care Case Management team, and have the ability to work with individuals from Populance, HAP, and Henry Ford Health. If you have a passion for community health, we want to meet you!
Interested in learning more about Populance? Check us out here: About Us | Populance – Detroit, MI
Under the guidance of the Clinical Success leadership team, the Client Focused Case Manager is responsible for the collaborative practice of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health care needs though communication and available resources to promote patient safety, quality of care and cost-effective outcomes. The Client Focused Case Manager will offer continuous assistance and monitoring regarding the efficiency and appropriateness of healthcare services for clients. This involves assessing the effectiveness of medical diagnostics, treatments, and services to create optimized, evidence-based pathways that ensure the right care is provided at the right time, promoting a person’s best state of health.
This role handles cases requiring extensive management, knowledge of benefits and resources. Essential skills include strong communication, problem-solving, critical thinking, and the ability to work independently in a fast-paced environment.
Dependent on volume, the Client Focused Case Management Nurse may also be responsible for handling case management requests within the state of Michigan.
- Assess both clinical and social determinants of health (SDOH) to determine the need for healthcare services and drive improvements in utilization practices.
- Conducts research across various platforms, including Epic, to gather comprehensive data on the client’s healthcare history, current needs, and utilization patterns.
- Conducts a comprehensive assessment of patient’s and family/caregiver’s biomedical, psychological, social, and functional needs to gage the potential impact on recovery.
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.
- A degree in nursing required.
- Bachelor’s degree in nursing preferred.
- A minimum of 2 years of experience in the health care industry, preferably in a health plan setting, required.
- Experience in Case Management required.
- Experience in Utilization Management preferred.
- Experience in Health Plan preferred.
- General understanding of Medicare and Medicaid regulations, required.
- General understanding of MDHHS, DIFS, CMS, NCQA regulatory requirements required.
- Knowledge of medical ethics and legal implications related to case management.
- Ability to prioritize and reprioritize quickly.
- Strong computer skills and knowledge.
- Registered Nurse (RN) with a valid, unrestricted State of Michigan license, AND Registered Nurse (RN) with a valid, unrestricted Muti-State Licensure. RN must reside in a state that is part of the Nurse Compact state licensure.
- Certification in Case Management (CCM) by the Commission for Case Management Certification (CCMC) preferred.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at [henryford.com/careers](http://henryford.com/careers).
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.