Job Summary

　　Plans and prioritizes care for individuals and population of patients, focusing on strategies that will promote optimal health within populations. Demonstrates expertise, current knowledge in care and management of a caseload of members of varying complexity and seeks to improve member, family, and health systems / community outcomes through the application of educational concepts / skills and preventive care in a managed care environment. Collaborate with providers, community organizations, and systems to coordinate care and ensure members and their families are connected to the resources needed to promote health and wellbeing, and advocate and address any barriers to access needed services.

　　Essential Functions

　　Develops and prioritizes plans to meet needs and provides services. Follow up with families, and community agencies to evaluate effectiveness of services provided and plan for future needs.

　　Develops plan of care and makes recommendations to PCPs, specialists and other members of the health care team regarding care management strategies, identifying strategies to maximize continuity of care across the continuum.

　　Assess internal and external referrals to meet identified member and their family's needs, level of intensity, mandated reporting referrals, insurance benefits, and other member resources.

　　Communicates and collaborates with member/significant others/providers/payers to coordinate services that improve access to appropriate services across the continuum of care and which promotes optimal health in a cost-effective manner.

　　Measure member care outcomes, interprets reports, and analyzes data trends for groups of members.

　　Documents member data, plan, interventions and outcomes according to department guidelines.

　　Ensures processes and services are continuously monitored for quality, cost effectiveness, and efficiency, Engages in process and quality improvement activities. Makes and implements recommendations to improve operational efficiency and to implement new services for areas of responsibility,

　　Assesses the educational needs of members, families and members of the health care team and develops and implements appropriate teaching strategies or makes referrals. Maintains knowledge of current trends and developments in the field

　　Qualifications

　　Required Bachelor's Degree or equivalent Nursing or a health care related field; OR

　　Required Master's Degree Social work

　　5 years of relevant experience LMSW - clinical and/or case management/managed care or related field OR Clinical Nursing and /pr case management/managed care or related field Required

　　LIC-Master Social Worker (MSW-Master) - STATE_MI State of Michigan Upon Hire required Or

　　LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire required

　　CRT-Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred

　　Pediatrics or Children's Special Care experience preferred

　　Case management experience preferred

　　Physical Demands

　　Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 20 lbs

　　Waist to Waist > 5 lbs: Seldom up to 20 lbs

　　Waist to Chest (below shoulder) > 5 lbs: Seldom up to 5 lbs

　　Waist to Overhead > 5 lbs: Seldom up to 5 lbs

　　Bilateral Carry > 5 lbs: Seldom up to 10 lbs

　　Unilateral Carry > 5 lbs: Seldom up to 10 lbs

　　Pushing Force > 5 lbs: Seldom up to 25 lbs

　　Pulling Force > 5 lbs: Seldom up to 20 lbs

　　Sitting: Frequently

　　Standing: Frequently

　　Walking: Frequently

　　Forward Bend - Standing: Seldom

　　Forward Bend - Sitting: Seldom

　　Trunk Rotation - Standing: Seldom

　　Trunk Rotation - Sitting: Seldom

　　Squat: Seldom

　　Stair Climbing: Seldom

　　Reach - Above Shoulder: Seldom

　　Reach - at Shoulder or Below: Seldom

　　Handling: Seldom

　　Forceful Grip > 5 lbs: Seldom

　　Forceful Pinch > 2 lbs: Seldom

　　Finger/Hand Dexterity: Occasionally

　　Primary Location

　　SITE - Priority Health - 1231 E Beltline - Grand Rapids

　　Department Name

　　PH - Care Management - Medicaid

　　Employment Type

　　Full time

　　Shift

　　Day (United States of America)

　　Weekly Scheduled Hours

　　40

　　Hours of Work

　　8 a.m. to 5 p.m.

　　Days Worked

　　Monday to Friday

　　Weekend Frequency

　　N/A

　　CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

　　Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

　　Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

　　An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

　　You may request assistance in completing the application process by calling 616.486.7447.

　　People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.