Senior Community Care Manager

Role Overview: The Senior Community Care Manager supports members in community-based care coordination and case management programs while collaborating across the Medical Management department to ensure alignment with organizational initiatives and strategic goals.Work Arrangements:Remote – Associate must reside in the state of Michigan (MI); preferred counties include Wayne, Oakland, and Macomb. Responsibilities:Serves as a single point of contact for member questions in collaboration with telephonic care managers and the Community Care Management Team (CCMT)Conducts in-home environmental and physical assessments for high-risk members to identify unmet needs and barriers to careDevelops and maintains individualized care plans, ensuring they are regularly reviewed and updatedProvides disease self-management education and coaching within the scope of practicePerforms medication reviews, including reconciliation during transitions of careCoordinates care across settings to ensure services are delivered in the least restrictive environment and supports transitions between care levelsConnects members to community, medical, and behavioral health resources to address barriers and support independent livingCollaborates with and oversees Community Care Connectors to facilitate access to in-community support servicesServe as a subject matter expert and supports leadership with operational activities, including training, mentoring, workflow coordination, referral review, and case assignmentMaintains a caseload and provides coverage for team members as needed to ensure continuity of careActs as a clinical and operational resource to address member needs and resolve complex issuesEnsures compliance with workflows, documentation standards, and regulatory requirements, including National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC) standardsEducation & Experience:Bachelor’s degree in nursing required. Current, active, and unrestricted Registered Nurse (RN) licensure. 3 plus years of case management experience. 1 year of community care management experience. Home Health RN experience preferredCertification as a Case Manager within 2 years of hire. Licensure:Current, active, and unrestricted Registered Nurse (RN) licensure. Valid driver’s license with car insurance. Skills & Abilities:Strong clinical assessment skills with the ability to evaluate member needs and identify barriers to careStrong communication and interpersonal skills, with the ability to engage members and collaborate with interdisciplinary teamsAbility to educate and coach members on disease management and self-care strategiesCritical thinking and problem-solving skills to address complex member needs and resolve care issuesStrong organizational and time management skillsAbility to collaborate with and provide guidance to team membersKnowledge of healthcare regulations, accreditation standards, and complianceProficiency with documentation systems, care management platforms, and Microsoft Office tools