The Coord-Complex Case Mgmt coordinates various activities supporting case management process.
Negotiates with payors concerning continued access to care, authorization, level of care and/or other arrangements to facilitate the patient's timely transition through the care continuum. Notifies attending physician, treatment team, and others as needed.
Completes admission, continued stay and discharge authorization according to hospital policy and third-party payer guidelines.
Coordinates management of patient through various community resource options. Integrates information obtained from the patient's chart and from communications with various sources when discussing the level and intensity of care needed.
Maintains documentation of patient's behavior, responses and preferences related to the discharge management process.
Manages a caseload of assigned patients of which a proportion, e.g. 30 to 60 patients are actively followed by the complex care manager. Provides targeted interventions to avoid hospitalization and emergency room visits. Coordinates care across settings and helps patient/families understand health care options. Infrequent, but possibility of home visits.
Assesses over time the health care, educational, and psychosocial needs of the patient/family. Uses standardized assessment tools such as depression screening, functionality, and health risk assessment.
Collaborates with PCP(Primary/personal care physician), patient, and members of the health care team, including continuum of care settings and community. Responsible for developing a comprehensive individualized plan of care and targeted interventions. Continually monitors patient/family response to plan of care, and revises the care plan as indicated.
Provides patient self-management support with a focus on empowering the patient/family to build capacity for self-care.
One or more of the following:
Basic Life Support Provider certification from the American Heart Association (AHA) required. American Red Cross (ARC) CPR for Professional Rescuers card will be accepted upon hire but renewal must be a BLS Provider card from AHA.
Current State of Michigan license as an RN, NP, PA, or LMSW required.
Certified Case Management (CCM) preferrred.
Associate Degree in Nursing required Bachelor's degree preferred
Three years of experience with adult medicine and pediatric patients in primary care/ambulatory care, home health agency, skilled nursing facility, or hospital medical-surgical setting, within the past five years.
t. John Providence is committed to providing care to treat the entire person -- body, mind, and spirit. This philosophy of care underscores our heritage as a faith-based health system offering our patients so much more than medicine.
We are the largest provider of inpatient care in southeast Michigan and one of the largest employers in metro Detroit. St. John Providence provides comprehensive p...revention, primary care, and advanced treatment programs with more than 125 medical centers and four hospitals spanning four counties. Our Centers of Excellence offer expertise in cancer, heart and vascular, minimally invasive surgery, neuroscience, orthopedics, and weight loss.