Job Summary

A healthcare professional with a customer centric focus to coordinate, outreach to and respond to members regarding issues and questions related to medical conditions, benefits and coverage criteria. Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options. Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc. Act proactively on member's behalf with routine benefits, gaps in care and prior authorization processes. Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.

• Candidates in this role should reside in the East or Southwest region of Michigan, as HIDE will be implemented first in Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren, Macomb, Oakland, and Wayne counties which includes home visits in 2026.
• Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.
• Is the member's first point of contact into Care Management. Assesses and identifies the needs and evaluates to determine if the member needs complex care management. If the needs are not complex, assists the member to meet their health care needs.
• Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.
• Acts proactively on member's behalf with routine benefits, gaps in care and prior authorization processes.
• Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.
• Identifies barriers and social determinants of health and assists to address or eliminate these barriers.
• Manages a caseload up to 450 members with stable but complex conditions or rising risk related to chronic conditions.

Required:

• Michigan Licensed Bachelors prepared social worker or Limited License Masters prepared social worker or Limited License Bachelors prepared social worker.
• Skills/knowledge/abilities typically gained through less than 2 years of related work experience in a clinical office or health insurance setting.
• 3 years of relevant experience Working in an organization of size and complexity comparable to Corewell Health or managed care organization.

Preferred:

• 5 years of relevant experience Related work in a clinical office or health insurance setting.

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv.
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance.
• Traditional and Roth retirement options with service contribution and match savings.
• Eligibility for benefits is determined by employment type and status.

Primary Location: SITE - Beaumont Service Center - 26901 Beaumont Blvd

Department Name: PH - Care Management - DSNP

Employment Type: Full time

Shift: Day (United States of America)

Weekly Scheduled Hours: 40

Hours of Work: 8:00 a.m. to 5:00 p.m.

Days Worked: Monday to Friday

Weekend Frequency: N/A