RN Case Manager D-SNP

General Summary:

Responsible for case management activities for Health Alliance Plan (HAP) dual eligible members using a multi-disciplinary, patient-centered approach. Provides bio/psycho/social assessments, develops an individualized care plan, implements case management interventions, facilitates an interdisciplinary care team, coordinates care, monitors outcomes and evaluates the delivery of quality, cost effective health care services across the continuum of care. Oversees the day-to-day operations of member-centered comprehensive care coordination for members enrolled in dual government programs, while ensuring adherence to all regulatory requirements.

Principal Duties and Responsibilities:

• Facilitate access of healthcare services for dual eligible members and identify plans for strategies to reduce avoidable utilization and encourages appropriate resource use. Works with physicians and other health care providers to adjust plans of care as required.

• Provide liaison services to dual eligible members and providers. Represents HAP in the community to peers, physicians, and providers as a member advocate for the HAP dual eligible population.

• Conducts assessments of member’s needs including current health conditions, preventive screenings, medical service utilization, cognitive/functional status, social determinant of health concerns, including food insecurity, transportation and housing, and behavioral health concerns including depression and substance use screening.

• Collaborates with external resources/agencies and post-acute care health teams to optimize the members outcomes and improve the care experience when transitioning to the next level of care or home.

• Familiarity, comprehension, and compliance with the Dual Eligible Special Need Population Model of Care (MOC).

• Attend and actively participate in the dual eligible member advisory committee, offering oversight and resolution as necessary based on feedback received.

• Develop, implement, monitor, and modify a plan of care through an interdisciplinary and collaborative team process, in conjunction with the member, the caregivers and the healthcare team.

• Maintain a level of competency and knowledge related to case management, disease processes and acute illnesses to assist with care coordination.

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

• Maintains availability to member/family/caregiver as a resource to facilitate communication among the multidisciplinary team and to monitor services rendered. Remains involved throughout the member’s enrollment in the dual eligible plan.

• Develops and maintains relationships with internal and external resources to ensure member needs are met. Identifies the need for and coordinates mental health/substance abuse interventions within HAP (or designee).

• Uses independent, clinical judgment and discretion to address, resolve, and process problems impeding the diagnostic or treatment process. Proactively identifies and resolves delays and obstacles.

• Facilitates referrals for additional medical and ancillary services, including home healthcare, infusion therapy, palliative care, hospice, inpatient extended care facilities, and medical equipment and supplies, as needed.

• Participate in the development of cost savings opportunities through the identification of quality management, case management, and multi-disciplinary processes.

• Refer cases to Physician Advisors and/or Plan Medical Directors when appropriate, where quality issues are identified .

• Coordinate and assist in the development of innovative alternative care delivery mechanisms to meet special needs of members.

• Maintain electronic medical records including professional, clinical documentation to ensure continuity of care and compliance to regulatory requirements (e.g., HIPAA, D-SNP Model of Care, CMS guidelines).

This job description is to be used as a guide for accomplishing company and department objectives and covers only the primary functions and responsibilities of this position. It is in no way to be construed as an all-encompassing list of duties.

Education:

• Nursing Diploma required.

Preferred:

• Previous experience with dual eligible special needs population.

• Bachelor’s degree in nursing or health services related field.

Experience Required:

• Minimum of three (3) years of relevant clinical experience in the medical inpatient or ambulatory setting or specialty experience.

Preferred:

• Experience in medical case management, discharge planning, home health care, rehabilitative medicine, community health, managed care/health insurance preferred.

• Certified Case Manager.

Certifications/Licensures Required:

• Current Michigan Registered Nursing Licensure.

• Must possess a valid driver's license and maintain a driving record that meets the criteria specified through the Henry Ford Health Systems' Corporate Insurance Program.

Team Member Standards of Excellence:

• Display a positive attitude.

• Take ownership and be accountable.

• Offer open and constructive communication.

• Respond in a timely manner.

• Take pride in the system.

• Respect and be sensitive to privacy/confidentiality.

• Commit to team members.

• Honor and respect diversity.

• Maintain a clean and safe workplace environment.

Expected Competencies:

• Ability to prioritize and coordinate member care needs.

• Ability to conduct telephone based nursing and psychosocial assessments using excellent interpersonal skills.

• Highly organized, able to manage multiple tasks simultaneously.

• Ability to interact professionally with physicians, members, and internal/external customers.

• Computer skills including Windows and Microsoft Word and the ability to enter and retrieve data from relevant computer systems.

• Basic knowledge of managed care and case management principles.

• Knowledge of acute care, home care, sub-acute care, long-term care and hospice interventions.

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

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.

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