The Case Manager is an interdependent member of the patient-centered care team or treatment 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 though communication and available resources to promote patient safety, quality of care and cost effective outcomes. (Case Management Society of America , 2016) In this capacity the Case Manager 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. The Case Manager provides services to patients from ambulatory, inpatient or health plan settings.
Principle duties, responsibilities, knowledge and skills:
· Provides counseling to patients with serious illness, and their families, to help with coping psychological distress, and existential stress.
· Performs caregiver assessment and provides interventions for needs identified
· Provides counseling and education to help families talk to children about serious illness and death. Accesses and mobilizes community resources to meet the needs of children coping with the illness or death of a loved one.
· Provides extensive counseling to assist in advance care planning and completing an advance directive.
· Provides counseling to assist in completing a simple will.
· Leads team debriefs after stressful clinical events and helps plan team wellness activities.
· Provides bereavement resources to families and performs bereavement follow-up calls to high risk family members for patients who did not enroll in hospice
· Serves as a liaison for community based and home-based palliative care. Develops expertise in palliative care resources in the community and makes recommendations to primary case manager to best meet patient needs.
· Educates palliative medicine team members, fellows, and residents on the psychosocial aspects of palliative care through formal didactic presentations and informal teaching sessions.
· Collaborate with palliative medicine interdisciplinary teams to lead and participate in patient/family meetings to discuss serious news and goals of care.
Bachelor degree (or higher) in nursing or related professional field (i.e. social work, counseling, health education, etc.).
Minimum (3) three years of clinical experience.
Excellent verbal communication and written documentation skills.
Excellent customer service and interpersonal skills including the ability to interact with internal and external customers and all levels of the organization.
Strong problem-solving, analytical and decision making skills.
Strong computer skills and knowledge.
Experience in discharge planning, home health care, rehabilitative medicine, community health or managed care preferred.
Knowledge of preventive service guidelines, clinical practice guidelines, behavior change theory, Medicare and Medicaid regulations and case management principles.
Knowledge of medical ethics and legal implications related to case management.
Understanding of social determinants of health and their impact on a patient’s wellbeing.
Well versed in facilitating community resources to meet the needs of diverse populations.
Strong organizational, planning and implementation skills with the ability to handle multiple complex patient needs simultaneously.
Strong sense of compassion with the ability to successfully advocate for patients and their families.
Registered Nurse (RN) or a Licensed Social Worker (LMSW) with a valid, unrestricted State of Michigan license.
Certification in Case Management (CCM) by the Commission for Case Management Certification (CCMC) preferred.
For current employees, effective date 10/31/2019, certification is required by December, 2023.
For new hires, certification must be obtained within 3-years from date of hire.
Internal Number: 1913978
About Henry Ford Health System
Founded in 1915 by auto pioneer Henry Ford and now one of the nation's leading health care providers, Henry Ford Health System is a not-for-profit corporation managed by President and Chief Executive Officer Wright Lassiter III and governed by a 17-member Board of Trustees, with volunteer-led advisory and affiliate boards providing additional leadership.
It is comprised of hospitals, medical centers and one of the nation's largest group practices, the Henry Ford Medical Group, which includes more than 1,200 physicians practicing in over 40 specialties. The System's flagship, Henry Ford Hospital in Detroit, is a Level 1 Trauma Center recognized for clinical excellence in cardiology, cardiovascular surgery, neurology and neurosurgery, orthopedics, sports medicine, multi-organ transplants and cancer treatment.
With more than 31,000 employees, Henry Ford Health System is the fifth-largest employer in metro Detroit, and among the most diverse. Generating more than $1.7 billion of annual economic stimulus, it proudly acts as one of Michigan's anchor institutions.
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