Mercy Medical Center Clinton Case Manager In-Patient in Ann Arbor, Michigan48104

Department:

AA102_64510 Case Managers

Expected Weekly Hours:

40

Shift:

Position Purpose:

Job Description Details:

POSITION PURPOSE

Responsible for coordinating the health care plan for assigned patient population through the use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of the health care team . Evaluates care based upon quality, access, and cost-effectiveness. Maintains the continuum of care through the coordination and integration of all phases of patient care. Provides quality patient care considering age specific, developmental, cultural, and spiritual needs. Demonstrates unit/area designated competencies.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

  • Accountability for discharge planning/continuing care needs for assigned populations.

ASSESSMENT

  • a. Assesses, develops and implements continuing care plans based on identification of patient's health self-care, knowledge, and/or social support system deficits.

  • b. Conducts ongoing assessment and interdisciplinary collaboration regarding continuing care needs through the continuum.

  • c. Applies expertise regarding Service Provider Criteria, Insurance Coverage Criteria and identification of patient needs.

  • d. Performs pre-admission services prior to admission, when indicated. Assesses, educates and implements plans as needed.

INTERVENTION

  • a. Collaborates with interdisciplinary team regarding patient progress towards expected outcome and revisions to plan of care.

  • b. Initiates referrals to other provider and disciplines i.e., Infection Control, Risk Management, as indicated.

  • c. Refers to Social Work for extended care facility discharge plans.

  • d. Refers to Skilled Home Care, Durable Medical Equipment vendors and other appropriate referral sources to assist patient in achieving a safe, optimal continuing care plan.

  • e. Collaborates with patient/family to ensure appropriate continuity of care arrangements and agency/vendor.

DOCUMENTATION

  • a. Documents Case Management assessment and interventions as they occur. (See Documentation policy)

  • b. Assures appropriate clinical documentation provided to Continuity of Care Provider.

  • c. Processes referrals in a timely manner to ensure effective continuing care plan.

  • d. Evaluates effectiveness of continuing care plan.

  1. Utilization Review
  • a. Exercises clinical judgment and objective application of Severity of Illness Antensity of Service (SIAS) criteria in assessing patients' medical conditions, level of care requirements and evaluation of adverse outcomes.

  • b. Directly intervenes to resolve complex utilization review functions and roles.

  • c. Provides clinical expertise to support utilization review functions and roles.

  • d. Initiates appropriate follow-up for patients not meeting clinical criteria.

3. System Case Management

  • a. Assists in collection of clinical/financial data to evaluate quality and clinical effectiveness of services provided.

  • b. Develops, implements and evaluates strategies for cost effective utilization of resources and achievement of patient outcomes, within appropriate time frames.

  • c. Educates, advocates, and facilitates resolution of patient/family issues related to discharge planning, resource utilization, appropriate setting for care and continuing care needs.

  • d. Actively participates in ongoing Quality Improvement efforts through data collection, problem identification, CQIT membership and resolution work groups.

  • Effectively organizes and sets priorities

  • Maintains good rapport and cooperative relationships. Approaches conflicts in a constructive manner. Helps to identify problems, offers solutions and participates in their resolution.

  • Maintains the confidentiality of information acquired pertaining to patients, physicians, employees, and visitors to St. Joseph Mercy Hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places.

  • Assumes responsibility for performance of job duties in the safest possible manner to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

  • Behaves in accordance with the Mission, Vision and Values of St. Joseph Mercy Health System.

OTHER FUNCTIONS AND RESPONSIBILITIES

 

Performs other duties as assigned.

REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE

Education: Bachelors' Degree in Nursing required.

Experience: Three to five years related experience and clinically relevant knowledge of patient population.

Licensure: Current Registered Nurse License in State of Michigan.

REQUIRED SKILLS AND ABILITIES

  • Interpersonal skills to develop relationships necessary to accomplish assessment, interventions, discharge planning, etc, with a wide range of patients, families, hospital staff and community resources. Telephonic communication skills to develop professional rapport and provide clinical information to external agencies.

  • Analytic skills necessary to clinically assess patients' needs, and to develop, coordinate and prioritize appropriate treatment and discharge plans.

  • Excellent prioritization and organizational skills.

  • Ability to concentrate and pay close attention to detail for up to 90%of work time.

  • Ability to walk and stand between 50-80%of work time.

   

This document is intended to describe the generalized duties and responsibilities, the specialized job functions, and the essential requirements of this job. It is not intended to be an exhaustive statement of all supplemental duties, responsibilities, or non-essential requirements or reflect any accommodations made under the American’s with Disability Act, the Michigan Handicapper’s Act, or SJMHS’s Return to Work Program

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Trinity Health offers rewarding careers in a community environment with all the advantages of working at one of the nation's largest health systems. We provide high-quality, people-centered care in 22 states through our network of hospitals, facilities, community-based services, and continuing care locations - including home care, hospice, Program of All Inclusive Care for the Elderly (PACE), and senior living facilities. If you are looking for a rewarding clinical or administrative position, you'll find exceptional career possibilities, opportunities for advancement and a job with meaning at Trinity Health.

Trinity Health employs more than 131,000 colleagues across 22 states. We honor and embrace a diverse representation of people, ideas and backgrounds. Our dedication to diversity is evident in our commitment to training, education, recruitment, retention and development, as well as community partnerships and supplier diversity.

Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences and health practices of the communities we serve and to apply that knowledge to produce positive outcomes. We recognize that each of us has a different way of thinking and perceiving our world, and that our differences not only serve to unite us, but also lead to innovative solutions.