Registered Nurse (RN) - Case Management
Company: ChenMed
Location: Southfield
Posted on: June 26, 2025
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Job Description:
Job Description ChenMed is seeking a Registered Nurse (RN) Case
Management for a nursing job in Southfield, Michigan. Job
Description & Requirements - Specialty: Case Management -
Discipline: RN - Duration: Ongoing - Employment Type: Staff Salary
will be competitive and based on equitable consideration of
qualifications and experience. /n We’re unique. You should be, too.
We’re changing lives every day. For both our patients and our team
members. Are you innovative and entrepreneurial minded? Is your
work ethic and ambition off the charts? Do you inspire others with
your kindness and joy? We’re different than most primary care
providers. We’re rapidly expanding and we need great people to join
our team. The Community Care team is a multidisciplinary service
including Registered Nurse (RN) Community Care nurses, Licensed
Practical Nurse (LPN) Community Care nurses, Community Social
Workers (CSW) and Community Health Coordinator (CHC) who work with
our highest complexity patients and their primary care physicians
to meet their medical and social needs with the aims of fully
engaging them in our intensive primary care model and maximizing
their healthy time at home. The Register Nurse (RN) Community Care
Nurse will serve as a clinical lead for a Community Care team. They
will coordinate the team’s efforts to stabilize our highest risk
patients, with special areas of focus including safe transitions of
care from facilities back to our primary care teams, stabilization
of our highest risk ambulatory patients and outreach to patients
who are assigned to us but are not engaged in care. This person
will perform initial assessments and design comprehensive plans of
care for many of these patients. This professional will also
provide clinical supervision to other team members in delivering
the plan of care and in other tasks necessary to meet their needs
and engage them in care. As a clinical leader for the team, this
person will also be deeply involved in prioritizing team efforts
and may also become the direct supervisor for some team members.
This position adheres to strict departmental goals/objectives,
standards of performance, regulatory compliance, quality patient
care compliance and policies and procedures ESSENTIAL JOB
DUTIES/RESPONSIBILITIES: - Provides in home and telephonic visits
to patients at high-risk for hospital admission and readmission (as
identified by CM Plan). Main goal to prevent and admission or
readmission to the ER/hospital . - Provides home visits to perform
initial assessment of patient and the development of care plan for
the Licensed Practical Nurse (LPN) to use as they perform the
follow up patient visits, once patient has completed their episode
of care management the register nurse (RN) will review patient
chart for discharge and conduct final discharge with patient. -
Conducts supervisory visits with License Practical Nurse (LPN) and
patient to provide any additional education patient may need and to
oversee appropriate patient discharge from case management. -
Performs clinical and Social determination of Heath screening
(SdoH) assessments to include disease-oriented assessment and
monitoring, medication monitoring, health education and self-care
instructions in the outpatient in home setting. Coordinate the Plan
of Care: - Conducts/coordinates initial case management assessment
of patients to determine outpatient needs. - Ensures individual
plan of care reflects patient needs and services available in the
community or review of their benefits. - Completes individual plan
of cares with patients, family/care giver and care team members. -
Communicates instructions and methodologies as appropriate to
ensure that the plan is implemented correctly. - Assesses the
environment of care, e.g., safety and security. - Assesses the
caregiver capacity and willingness to provide care. - Assesses
patient and caregiver educational needs. - Coordinates, reports,
documents and follows-up on multidisciplinary team meetings. -
Helps patients navigate health care systems, connecting them with
community resources; orchestrates multiple facets of health care
delivery and assists with administrative and logistical tasks. -
Coordinates the delivery of services to effectively address patient
needs. - Facilitates and coaches’ patients in using natural
supports and mainstream community resources to address supportive
needs. - Maintains ongoing communication with families, community
providers and others as needed to promote the health and well-being
of patients. - Establishes a supportive and motivational
relationship with patients that support patient self-management -
Monitors the quality, frequency, and appropriateness of HHA visits
and other outpatient services. - Assists patient and family with
access to community/financial resources and refer cases to social
worker as appropriate. - Home visit under the direction of the
patient’s primary care physician to meet urgent patient needed. -
Performs other duties as assigned and modified at manager’s
discretion. KNOWLEDGE, SKILLS AND ABILITIES: - Strong interpersonal
and communication skills and the ability to work effectively with a
wide range of constituencies in a diverse community. - Critical
thinking skills required. - Ability to work autonomously is
required. - Ability to monitor, assess and record patients’
progress and adjust and plan accordingly. - Ability to plan,
implement and evaluate individual patient care plans. - Ability to
work as oversight for License Practical Nurse (LPN) for initial
assessments, plan of care and supervisory visits including proper
discharge of a patient from case management. - Knowledge of nursing
and case management theory and practice. - Knowledge of patient
care charts and patient histories. - Knowledge of clinical and
social services documentation procedures and standards. - Knowledge
of community health services and social services support agencies
and networks. - Organizing and coordinating skills. - Ability to
communicate technical information to non-technical personnel. -
Proficient in Microsoft Office Suite products including Excel,
Word, PowerPoint, and Outlook, plus a variety of other
word-processing, spreadsheet, database, e-mail and presentation
software. - Ability and willingness to travel locally, regionally,
and nationwide up to 10% of the time. - Spoken and written fluency
in English. Bilingual a plus. - This job requires use and exercise
of independent judgment EDUCATION AND EXPERIENCE CRITERIA: -
Associate degree in Nursing required. - Bachelor’s Degree in
nursing (BSN) or RN with bachelor’s degree in home in a related
clinical field preferred. - A valid, active Registered Nurse (RN)
license in State of employment required. - A minimum of 2 years’
clinical work experience required. - A minimum of 1 year of case
management experience in community case management experience
highly desired. - This position requires possession and maintenance
of a current, valid driver’s license. - Certified Case Manager
certification is preferred. Certification through the Commission
for Case Manager Certification (CCMC) or the American Association
of Managed Care Nurses (CMCN) desired. We’re ChenMed and we’re
transforming healthcare for seniors and changing America’s
healthcare for the better. Family-owned and physician-led, our
unique approach allows us to improve the health and well-being of
the populations we serve. We’re growing rapidly as we seek to
rescue more and more seniors from inadequate health care. ChenMed
is changing lives for the people we serve and the people we hire.
With great compensation, comprehensive benefits, career development
and advancement opportunities and so much more, our employees enjoy
great work-life balance and opportunities to grow. Join our team
who make a difference in people’s lives every single day. Current
Employee apply HERE Current Contingent Worker please see job aid
HERE to apply ChenMed Job ID R0043235. Posted job title: Registered
Nurse Community Case Manager About ChenMed At ChenMed, we’re
shaping the future of value-based care. Our patient-centered,
preventive care approach is aimed at improving health outcomes for
seniors. We serve our communities in over 100 medical centers
across 12 states and prioritize our team members with competitive
compensation and benefits and with our purpose-driven culture.
Working at ChenMed is more than just your next opportunity, you
will feel rewarded from day one as your contribution will truly
make an impact in both the health and lives of seniors. Benefits -
Employee assistance programs - Medical benefits - Holiday Pay -
Dental benefits - Benefits start day 1 - Life insurance -
Guaranteed Hours - Sick pay - Vision benefits - 401k retirement
plan - Wellness and fitness programs - Mileage reimbursement -
Discount program
Keywords: ChenMed, Southfield , Registered Nurse (RN) - Case Management, Healthcare , Southfield, Michigan
