This is a great role for a registered nurse (RN) seeking an opportunity to use their clinical experience in the capacity of Case Manager serving HAP members enrolled in the Dual Eligible Special Needs Plan (D-SNP) program. D-SNP is a type of health insurance plan for individuals eligible and enrolled in both Medicare and Medicaid. This position will be mostly remote with occasional required in person meetings and training at the HAP corporate office in Troy, MI.

GENERAL SUMMARY:

Under minimal supervision, facilitates the care of HAP members in the inpatient care setting to ensure quality outcomes and appropriate utilization of health care resources. The case manager works in collaboration with a multidisciplinary team in planning, implementing and evaluating medical and nursing services. Responsible for the case management activities of high risk members transitioning to the outpatient setting. Provides bio/psycho/social assessments, develops an individualized care plan, implements case management interventions, coordinates care, monitors outcomes and evaluates the delivery of quality, cost effective health care services across the continuum of care.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Conducts a comprehensive assessment of member and family/caregiver’s psychosocial functioning and needs as they relate to acute and chronic illness.

• Participates in the development of a care plan with the multidisciplinary health care team, member and family/caregivers.

• Identifies and plans strategies to reduce avoidable re-admissions and emergency room visits. Works in coordination with physicians, discharge planners and other health care providers. Arranges for supportive services such as physician office visits, physical therapy, occupational therapy, speech therapy, cardiac rehabilitation, pulmonary rehabilitation, etc. as needed.

• Provides education to improve health literacy and counseling to members and their family. Topics include, but not limited to: healthy lifestyles, preventative services, disease processes/clinical practice guidelines, and self-management strategies.

• Engages members in goal setting and action planning to assist in achieving optimum levels of health.

• Utilizes professional judgment and critical thinking in identifying and assisting members in overcoming barriers to goal achievement.

• Advocates for the member and/or family throughout episodes of care.

• Works in collaboration with contracted facilities to facilitative effective communication among members of the multidisciplinary care team and to monitor progress.

• Develops and maintains relationships with internal and external resources to ensure member needs are met.

• Collaborates with management to design and establish program improvements.

  EDUCATION/EXPERIENCE REQUIRED:

• Associate’s degree in Nursing.

• Three (3) years of relevant clinical nursing experience in medical inpatient, ambulatory setting, specialty care, discharge planning, home health care, community health, rehabilitative medicine or chronic disease health coaching.

• Bachelor’s degree in related field, preferred.

• Experience in patient care coordination, case management, managed care/health insurance, preferred.

• Superior communication and conflict management skills allowing for the management of complex issues with effective diplomacy.

• Excellent written and interpersonal communication skills.

• Excellent documentation.

• Strong problem solving, analytical and decision making.

• Strong organizational, planning and implementation.

• Well-developed time management and prioritization.

• Creative and resourceful.

• Organizational skills required to manage priorities as dictated by business needs.

• PC literacy.

• Ability to identify, assesses, and solve highly complex problems relating to team dynamics, benefits administration, and the delivery of health services.

• Knowledge of clinical pharmacology and implications.

• Understanding of community resources.

• Knowledge of case management goals, strategies and measurement.

• Medical management processes across the continuum of care.

• Knowledge of medical ethics and legal implications of case management.

• Understanding of the needs of diverse populations.

  CERTIFICATIONS/LICENSURES REQUIRED:

• Current Michigan Registered Nursing Licensure

• CCM - Certification in Case Management, preferred.

• ACM - Accredited Case Management, preferred.

• CCP - Chronic Care Professionals Certification, preferred.

Additional Information

• Organization: HAP (Health Alliance Plan)

• Department: Case Management

• Shift: Day Job

• Union Code: Not Applicable

  Additional Details

  This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .

Benefits

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.