911206 - Integrated Case Mgr-Resident

GENERAL SUMMARY:

The Integrated Case Manager-Resident is a 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 though communication and
available resources to promote patient safety, quality of care and cost effective
outcomes. Addresses the needs of 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. Provides services to
patients in ambulatory or hospital setting.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

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. Collaborates with other members of the care team to develop personalized patientcentered 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. Serves as resource related to treatment decisions and end of life issues including
Advanced Care Planning.
5. Provides coordination as necessary to ensure patients seamlessly and safely transition
between care settings.
6. Collaborates with appropriate members of the patient's treatment/care team to comanage patients with complex medical and social needs. Participates in collaborate
care conferences.
7. Continually evaluates the patient's response to the care/treatment plan making
modifications when necessary.
8. Performs other duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Master degree in Social Work from an accredited program required.
• Ability to assess, identify barriers and work in collaboration with other members of the
  care team to meet patient's social and clinical needs.
• Strong verbal communication and written documentation skills.
• Strong customer service and interpersonal skills with the ability to interact with all
  members of the patient's care team.
• Strong problem-solving, analytical and decision-making skills.
• Strong sense of compassion with the ability to successfully advocate for patients and
  their families.

CERTIFICATIONS/LICENSURES REQUIRED:

• Limited Licensed Social Worker (LLMSW) with a valid, unrestricted State of Michigan
  license.
• Must obtain full licensure (Licensed Master Social Worker-LMSW) within 12 months of
  completing 4,000 supervised hours.

Must meet or exceed core customer service responsibilities, standards and behaviors as
outlined in the HFHS' Customer Service Policy and summarized below:

• Communication
• Ownership
• Understanding
• Motivation
• Sensitivity
• Excellence
• Teamwork
• Respect

Must practice the customer skills as provided through on-going training and in-services.

Must possess the following personal qualities:

• Be self-directed
• Be flexible and committed to the team concept
• Demonstrate teamwork, initiative and willingness to learn
• Be open to new learning experiences
• Accepts and respects diversity without judgment
• Demonstrates customer service values

PHYSICAL DEMANDS/WORKING CONDITIONS:

• Ability to work in an interprofessional team.
• Ability to travel to meet with patients/members as needed in a variety of care settings
  (specialty appointments, hospital, skilled nursing facilities, etc.).
• Demonstrates flexibility in an environment of constant change.
• Work in a clinical environment with potential exposure to communicable disease.

Salary : $6 - $90