Senior Case Manager

McLaren Health Care Flint, MI
Subsidiary: McLaren Health Plan -

McLaren Health Plan, recognized by Modern Health Care as one of the 100 Best Places to Work in Health Care for four years in a row, is seeking a Senior Case Manager to join our Medical Management team!

JOB SUMMARY

Responsible for the integration, coordination and continuity of health care services delivered to the membership for all assigned product lines. Identifies members who would benefit from care management by assessing aberrant utilization patterns, presence of multiple diseases, reinsurance cases, and problematic pharmacy utilization opportunities. Focuses on the delivery of HRA and pre-assessments with the goal to proactively manage complex cases, including catastrophic cases. Coordinates and participates in the medical management of complex case management encompassing members identified for case management or enrolled in disease management programs. Collaboratively works with the medical management staff and senior management on complex cases, with attention to areas such as health and wellness, medical and pharmacy utilization patterns, discharge planning after inpatient utilization, and coordination of medical and behavioral needs. Coordinates problem solving and develops care plans for complex cases. Special Needs Plan lead for the Interdisciplinary Care Team (ICT). First line resource for the medical management staff for any medical management need. Responsible for appropriate NCQA standards and HEDIS rates per assigned product lines. Leads special projects as assigned.

REQUIRED QUALIFICATIONS

* RN with a valid unrestrictive Michigan license

* Bachelor of Science in Nursing, Health Administration, or related field. An equivalent combination of relevant education and experience may be substituted for the educational requirement.

* 5 years clinical nursing experience

* 5 years experience in Managed Care Utilization Management, Medical Management, or Case Management

* Complex Case Manager (CCM) Certified within one year of placement in position

PREFERRED QUALIFICATIONS

* 8 years clinical experience

* Masters in Nursing or related field

NOTE: To further our mission of enhancing the health status of the individuals and communities we serve, effective February 1, 2013, McLaren Health Plan will no longer hire individuals who use tobacco or nicotine products in any form. Cotinine testing will be used to verify non-tobacco use. Individuals whose health screening results are verified positive for tobacco/nicotine use will be disqualified from employment, their job offer will be rescinded, and they will be disqualified from reapplying for employment for six (6) months from the date of the health screening.

* Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

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