Integrated Case Manager

Job Title: Integrated Case Manager
Job :78103
Location: Detroit, Michigan

Overview:
The Integrated Case Manager for Population Health is an interdependent member of the patient-centered care team responsible for the collaborative practice of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family’s comprehensive health care needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes. Addresses the needs of patients who have experienced a critical event or diagnosis that requires complex management strategies and the extensive use of resources to optimize health outcomes along the care continuum.

Provides services to patients from ambulatory, inpatient, or health plan settings.

What you will be doing:

• Conducts a comprehensive assessment of patient and family/caregivers' biomedical, psychological, social, and functional needs to gauge the potential impact on recovery.
• Develops personalized patient-centered care plans aimed at optimizing the patient's care experience.
• Engages patients and their families as part of the care team through advocacy, ongoing communication, health education, identification of resources, and service facilitation.
• Utilizes professional judgment, critical thinking, motivational interviewing, and self-management techniques to assist patients in overcoming barriers to goal achievement.
• Provides counseling and interventions related to treatment decisions and end-of-life issues, including Advanced Care Planning.
• Provides coordination as necessary to ensure patients seamlessly and safely transition between care settings.
• Advocates for appropriate delivery of services within the patient's health plan benefit structure.
• Collaborates with appropriate members of the patient's treatment/care team to co-manage patients with complex medical and social needs. Facilitates interdependent collaborative care conferences.
• Continually evaluates the patient's response to the care/treatment plan, making modifications when necessary.
• Plans and participates in process improvement activities designed to reduce risk, inclusive of data collection, analysis, and follow-up intervention activities.
• Facilitates interventions in cases involving child abuse and neglect, domestic violence, elder abuse, institutional abuse, and sexual assault.
• Supports department-based goals, which contribute to the success of the organization.
• Performs other duties as assigned.

What you must have:

• Previous acute inpatient case management experience.
• 3-5 years of case management experience.
• Strong computer skills.
• Epic EMR experience.
• BLS certification from AHA.