Case Manager, Registered Nurse - LTSS

Responsibilities 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 (ICT) 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 all case management activities in accordance with regulatory and accreditation standards. Educate members and caregivers regarding benefits, services, and available community resources. 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 is required. Proficient in electronic medical records and care management platforms. #J-18808-Ljbffr Jobtailor