We are looking for a Medical Managment Team Lead - RN to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live 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 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 Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.  Learn more about MDwise, Inc. at https://www.mdwise.org/

Position Overview:  Provides clinical oversight of staff and functions to meet organizational goals in utilization, disease, case and medical management.  Responsible for providing expert knowledge of screening criteria, clinical criteria and research ability if no criteria exist. Uses independent judgment, when necessary, within scope of practice. Participates in the medical management of members for all product line.  Works with the PCP, the member, the case management RN team 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 case management RN Team, Medical Director and senior management on complex cases.  Assists where necessary or through project management for those business ventures undertaken by the Company to ensure its profitable future.

This is a fully remote position.

This position requires Michigan Residency.

This position requires occasional weekend and on call availability. 

This position does have occasional travel for conferences and meetings. 

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Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Qualifications:

Required:

·        RN with a valid unrestricted license from state employed in

·        Two (2) years clinical nursing experience

·        Three (3) years’ experience in progressively more complex case management in a managed care organization

Preferred:

·        BSN

·        One (1) year experience in claims administration, including CPT codes, revenue codes, HCPCS codes, DRGs, etc.

·        Five (5) years’ experience and knowledge of Medicaid (e.g utilization management, medical management)

Additional Information Schedule: Full-time Requisition ID: 24005962 Daily Work Times: 8:30am - 5pm Hours Per Pay Period: 80 On Call: Yes Weekends: Yes