About the Department

The Corewell Health West Ambulatory Care Management Department is made up of Social Workers, RN Care Managers, Community Health Workers and Medical Assistants. We have a large team of Social Workers and RN Care Managers who are embedded in Primary Care offices across the system. Care Management work is focused on identifying and connecting with patients who have behavioral health concerns or chronic medical conditions on an outpatient basis and assisting these patients with developing healthy behaviors and coping skills that will improve overall health outcomes. Our Ambulatory Care Managers play an active role on the patient’s care team and partner with primary care providers in developing an appropriate treatment approach for patients experiencing chronic disease and/or behavioral health concerns to promote self-management and symptom improvement. The Ambulatory Care Management team also provides comprehensive transitions of care support to patients who have been admitted to the hospital in an effort to keep patients well in the community, prevent readmissions and reduce overall cost of care. Resources and support for barriers related to Social Determinants of Health (SDoH) is also provided to primary care patients by our remote team of Community Health Workers. The Ambulatory Care Management Department has consistently demonstrated successful outcomes through the interventions provided to patients.

About Outpatient Clinics

Corewell Health operates over 300 outpatient clinics across Michigan, bringing a multitude of care options to the communities that we serve. There are over 40 different types of primary care and specialty practices, which allows those who work in these clinics the opportunity to learn and explore various interests or to specialize in one area.

Scope of work

Plans and prioritizes care for individuals and population of clients, focusing on strategies that will promote optimal health within populations. Provides peer support and role modeling related to the development of life skills and health/wellness to individuals and families during home visits, if applicable. Demonstrates expertise, current knowledge in patient care and management of a caseload of clients of varying complexity and seeks to improve patient, family and health systems/community outcomes through the application of educational concepts/skills and preventive care in a managed care environment.

• Assesses internal referrals and may provide individual, short-term therapy services or care management services and monitors patient progress.

• Develops plan of care and makes recommendations to PCPs, specialists, and other members of the health care team regarding mental health treatment strategies and identifies strategies to maximize continuity of care across the continuum.

• Assesses and provides follow-up for the Systematic Case Review process which includes consultation with psychiatrist and serves as liaison between PCP and consulting psychiatrist to assist in psychotropic medication management for patients.

• Responds to patients’ urgent mental health concerns, including suicide risk assessments and assists patient in accessing appropriate level of care.

• Professional development opportunities through peer case review and monthly continuing education opportunities

How we will care for you, while you care for our patients

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here (https://careers.corewellhealth.org/us/en/benefits-new) .

• 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

Qualifications

• LMSW Social Worker – State of Michigan License Upon Hire required

• 2 years of relevant experience related field Required

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here (https://careers.corewellhealth.org/us/en/benefits-new) .

• 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 - Fremont Medical Office Building - 230 W Oak St - Fremont

Department Name

Multi-Specialty/Family Medicine - Fremont

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. - 5:00 p.m.

Days Worked

Monday - Friday

Weekend Frequency

N/A

CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.