Case Management Nurse
Company: Access Health, Inc.
Location: Muskegon
Posted on: February 24, 2021
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Job Description:
Access Health is a non-profit organization created in 1999 to
address the needs of our community by developing programs &
partnerships aimed at helping people to improve & achieve their
optimal health. Our primary focus is providing access to affordable
health coverage to the working uninsured. We are excited expand our
team as we continue our path of transformative innovation.Our
Company Culture: Our guiding principles are at the center of
everything we do. We're here to help our members, our community and
ourselves make real changes that lead to optimal, sustained health
outcomes. We approach every relationship with extraordinary care
and empoyerment. We believe that sucess will follow only when we do
the right thing by our members, our community and our staff. We
have the courage to do what's right, even when it's
difficult.Benefits: Health, Dental, and Vision insuranceDisability
insuranceLife insurancePaid time offTuition
Reimbursement401(k)Responsibilities:Management: The Case Manager is
responsible for ensuring clinical excellence within both
administrative and medical capacities to ensure that establishment
runs smoothly, including management and oversight of clinical and
member services staff. This position will design clinical
operations programs and processes to meet strategic needs and
anticipate future strategic changes. The Case Manager will be
responsible for providing strategic leadership for the Company by
working with the management team to establish long-range goals,
strategies, plans and policies.Clinical: The Case Manager will be a
member of the clinical team within Access Health, Inc. and provide
onsite and telephonic case management services to individuals
identified as "high risk members. This position will serve as the
primary point-of-contact for a selected group of members with the
goal of improving quality outcomes and optimizing service
utilization and cost. The position will incorporate education to
staff, clients and the community on chronic disease conditions,
incorporation of the domains of health into the health narrative
and utilization of community resources.* Responsible for the day to
day management of the Clinical and Member Services departments.*
Oversees quality components (disease management, utilization
management, and accreditation and wellness programs).* Manage the
recruitment, development, appraisal and mentoring of staff.*
Reviews policies, procedures, and protocols no less than annually
and revises policies as necessary with approval of the Clinical
Committee.* Reviews new standards of care and bring suggestions to
the Clinical Committee.* Mentors staff to ensure adherence to AHI
utilization standards and report utilization variances.* Provides
leadership and direction in the implementation of projects
initiatives to ensure goals are met and provide value of service
for plans and customers. Collaborate with others in the
organization to ensure project team efforts accomplish objectives
in a timely and successful manner.* Evaluate and report the
outcomes of care coordination programs and/or individual care
coordination activities.* Provide clinical expertise in individual
benefit interpretations, consistent with established Access Health
plan benefit policies.Required Minimum Education: Graduate of an
accredited school of nursing; Baccalaureate degree in nursing (BSN)
preferred, LPN will be considered as well. Will need to obtain
Managed Care Nurse Certification within 6 months of hire.Required
Minimum Licensure/Certification: Current licensure in Michigan as a
Registered Nurse or Licensed Practical Nurse.Required Minimum
Experience: Three to five years of recent experience in a clinical
health care setting with responsibilities reflecting direct
management of patient care including planning, coordination, and
delivery of needed services such as education, psychosocial
support, discharge planning and utilization management. Supervisory
or leadership experience is preferred. Bilingual preferred. Mental
health experience preferred.Job Type: Full-time, on site.COVID-19
note: All staff members have private offices with doors. Masks are
worn at all times in all common areas. Meetings are held via zoom
or Microsoft Teams. Our building is currently closed to the public.
We plan to conduct initial interviews by zoom or Microsoft
Teams.
Keywords: Access Health, Inc., Grand Rapids , Case Management Nurse, Executive , Muskegon, Michigan
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