We are looking for a Case Manager, RN to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise in Indiana. It is an organization with culture of high performance and a mission to help people life healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative, and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health plan at https://www.mclarenhealthplan.org .

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid to bring members the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org .

Position Summary:

This position is responsible for care management functions. This includes but is not limited to the following: participates in the medical management of members in assigned product lines, including case specific and disease management programs, including catastrophic cases. Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting. Performs as the member advocate with emphasis on education regarding managed care, disease management and PCP treatment plans. Monitors member's utilization patterns for identification of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and specialist projects.

Clinical expertise related to children and youth with special health care needs preferred.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Qualifications:

Required:

• RN with a valid unrestrictive license from state employed in state providing services.
• Two (2) years clinical nursing experience.
• One (1) year previous case management or utilization review experience.
  
  

Preferred:

• BSN.
• Two (2) years' experience in Managed Care Utilization Management, Medical Management, Case Management.
• Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions including understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
• Certified Case Manager (CCM) Certification.
  
  

Additional Information

• Schedule: Full-time
• Requisition ID: 25005002
• Daily Work Times: 8:30 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No