Description: Responsible for Case Management / discharge planning of patients either from the hospital to their home or another medical facility. The EMR (elctronic medical records) system they use is EPIC however it is not mandatory that they have used EPIC before. They will spend the majority if their time in supporting a specific unit however could be asked to help out in others if needed. *** THIS role will involve creating and implementing the patients discharge plan from their computer in an office. Case load is still being determined as they are still short in the department. Accuracy is very important though so they wont give individuals more then they can handle.
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
Overview: 1. Conducts a comprehensive assessment of patient and family/caregiver's biomedical, psychological, social and functional needs to gage the potential impact on recovery.
2. Develops personalized patient-centered care plans aimed at optimizing the patient's care experience.
3. Engages patients and their families as part of the care team through advocacy, ongoing communication, health education, identification of resources and service facilitation.
4. Utilizes professional judgment, critical thinking, motivational interviewing and self-management techniques to assist patients in overcoming barriers to goal achievement.
5. Provides counseling and interventions related to treatment decisions and end of life issues including Advanced Care Planning.
6. Provides coordination as necessary to ensure patients seamlessly and safely transition between care settings.
7. Advocates for appropriate delivery of services within the patient's health plan benefit structure.
8. Collaborates with appropriate members of the patient's treatment/care team to co-manage patients with complex medical and social needs. Facilitates interdependent collaborate care conferences.
9. Continually evaluates the patient's response to the care/treatment plan making modifications when necessary.
10. Plans and participates in process improvement activities designed to reduce risk, inclusive of data collection, analysis and follow-up intervention activities.
11. Facilitates interventions in cases involving child abuse and neglect, domestic violence, elder abuse, institutional abuse and sexual assault.
M-F, 8:00am - 5:pm These are 13 week assignments with 13 week extensions so long as performance metrics are being hit. Opportunity for direct hire and long term consultants both strong possibilities.
Additional Skills & Qualifications: Must Have:
Registered Nurse (RN) or a Licensed Social Worker (LMSW) with a valid, unrestricted State of Michigan license.
Bachelors or Associates Degree
At least one year of Inpatient Clinical Case Management experience and Discharge planning experience
BLS
Best Vs Average - Someone with extensive discharge planning experience
Performance Metrics - Determined after training based off of what they can handle
First Day/Week: Nursing orientation and shadowing of an experienced Case Manager
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