Job Description:
• Conduct comprehensive in-home LTSS assessments to determine eligibility for waiver and community-based services
• Complete and submit required waiver documentation in accordance with state Medicaid and health plan guidelines
• Develop and implement individualized, person-centered plans of care addressing medical, behavioral, functional, and social determinant needs
• Apply clinical judgment to identify risk factors, prevent avoidable hospitalizations, and reduce barriers to care
• Coordinate services across interdisciplinary teams including providers, home health agencies, behavioral health, and community organizations
• Review claims data, clinical records, and assessment tools to evaluate member needs and benefit utilization
• Monitor member progress and reassess needs based on changes in condition or level of care
• Present cases at interdisciplinary team meetings and collaborate with supervisors and stakeholders to ensure goal attainment
• Ensure compliance with Medicaid waiver requirements, CMS regulations, state LTSS guidelines, and company policies
• Document case management activities in accordance with regulatory and accreditation standards
• Educate members and caregivers regarding benefits, services, and available community resources
• Assess, plan, implement, and coordinate case management activities to facilitate members’ overall wellness
Requirements:
• Active, unrestricted Registered Nurse (RN) license in the state of Michigan
• Associate or Bachelor of Science in Nursing (BSN preferred)
• Minimum of 2 years of clinical nursing experience
• Minimum of 1 year of experience in case management, care coordination, home health, hospice, or long-term care
• Experience working with Medicare, Medicaid, or dual-eligible populations
• Knowledge of Long-Term Services and Supports (LTSS), home and community-based services (HCBS), and waiver programs
• Experience conducting in-home assessments and developing person-centered service plans
• Strong understanding of social determinants of health and community resource navigation
• Ability to travel 25–50% within assigned counties, including completion of in-home field visits
• Reliable transportation required
• Proficiency in electronic medical records and care management platforms
• Dedicated workspace free of interruptions
• Dependents must have separate care arrangements during work hours
• Certified Case Manager (CCM) or willingness to obtain within 2 years preferred
• Experience in managed care or health plan environment preferred
• Knowledge of Michigan Medicaid waiver programs and state LTSS regulations preferred
• Experience presenting cases in interdisciplinary team settings preferred
• Bilingual skills preferred
• Strong clinical assessment and critical thinking skills
• Excellent communication and member engagement skills
• Ability to manage a high-risk, complex caseload
• Regulatory and compliance knowledge
• Independent decision-making in a remote environment
• Ability to work independently
• Effective computer skills, including navigating multiple systems and keyboarding
• Proficiency with MS Word, Excel, Outlook, and PowerPoint
Benefits:
• 4 day/10-hour schedule available after training
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• Comprehensive benefits package for eligible full-time colleagues and their families