Healthcare Consultant III - Case Management Coordinator

Job Title: Healthcare Consultant III - Case Management Coordinator
Location: Lansing, MI 48933
Duration: 3+ months (possible extension)

Position Overview:

• Field and telephonic-based position.
• Candidates must reside in or near Wayne or Macomb Counties, MI.
• City/State, Zip, and County must be included at the top of the resume.
• Travel to the region is required.
• Must be a Registered Nurse (RN) with an active, unrestricted Michigan license.

 
Position Summary:
The Case Manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s benefit plan and/or health needs. Through effective communication and available resources, the Case Manager promotes optimal, cost-effective outcomes for members.
 
Duties & Responsibilities:

• Conduct comprehensive assessments of referred member’s needs and eligibility using clinical tools and data review.
• Determine approach to case resolution by evaluating the member’s benefit plan and available internal/external programs and services.
• Apply and interpret applicable criteria, guidelines, standardized case management plans, policies, procedures, and regulatory standards.
• Ensure appropriate administration of benefits while assessing member needs.
• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.
• Maintain documentation and follow established policies/procedures.

 
Experience & Skills:

• 3 years clinical practice experience (e.g., hospital, home health, or ambulatory care) required.
• Experience in healthcare and/or managed care industry.
• Case management experience preferred.
• Proficiency with computer systems, including navigating multiple platforms and keyboarding.
• Effective verbal and written communication skills.
• Ability to multitask, prioritize, and adapt to a fast-paced, changing environment.
• Sedentary work, including periods of sitting, talking on the phone, typing, and close inspection of documents and computer monitors.
• Ability to meet productivity and quality expectations in a typical office environment.

 
Education & Certification:

• Required: RN with active, unrestricted Michigan license.
• Preferred: Case Management Certification (CCM).