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Integrated Resources, Inc ( IRI )

RN Integrated Case Manager

Integrated Resources, Inc ( IRI ), Detroit, Michigan, United States, 48228

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RN Integrated Case Manager

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Job Summary The Integrated Case Manager for Population Health 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. The role addresses 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, providing services from ambulatory, inpatient or health plan settings.

Principle Duties and Responsibilities

Conduct a comprehensive assessment of patient and family/caregiver’s biomedical, psychological, social and functional needs to gauge the potential impact on recovery.

Develop personalized patient-centered care plans aimed at optimizing the patient’s care experience.

Engage patients and their families as part of the care team through advocacy, ongoing communication, health education, identification of resources and service facilitation.

Utilize professional judgment, critical thinking, motivational interviewing and self-management techniques to assist patients in overcoming barriers to goal achievement.

Provide counseling and interventions related to treatment decisions and end-of-life issues including advanced care planning.

Provide coordination as necessary to ensure patients seamlessly and safely transition between care settings.

Advocate for appropriate delivery of services within the patient’s health plan benefit structure.

Collaborate with appropriate members of the patient’s treatment/care team to co-manage patients with complex medical and social needs, facilitating interdependent collaborative care conferences.

Continually evaluate the patient’s response to the care/treatment plan, making modifications when necessary.

Plan and participate in process improvement activities designed to reduce risk, inclusive of data collection, analysis and follow-up intervention activities.

Facilitate interventions in cases involving child abuse and neglect, domestic violence, elder abuse, institutional abuse and sexual assault.

Support department-based goals that contribute to the success of the organization.

Perform other duties as assigned.

Required Skills & 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.

Education

Nursing degree

MSW (Master of Social Work)

Required Certification & Licensure

Registered Nurse (RN) with a valid, unrestricted State of Michigan license.

Licensed Social Worker (LMSW) with a valid, unrestricted State of Michigan license.

Seniority Level Mid-Senior level

Employment Type Full-time

Job Function Other

Industries IT Services and IT Consulting

Location Detroit, MI

Additional Information Referrals increase your chances of interviewing at Integrated Resources, Inc (IRi) by 2x. Get notified about new Case Management Nurse jobs in

Detroit, MI .

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