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We got a new job details in Henry Ford Health System & they are Hiring Candidates for Care Coordinator (Case Manager) – Health Alliance Plan
Company Name : Henry Ford Health System
Company Location : Troy, MI 48084
Job Position : Care Coordinator (Case Manager) – Health Alliance Plan
Job Category : Jobs in Michigan
Job Description :
This position is responsible for case management services provided to the membership of HAP Empowered Health Link within the framework of the Annual Case Management Plan.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Perform comprehensive clinical and diagnostic assessments for members meeting institutional level of care.
Clinical and diagnostic evaluation and review of chronic condition information related to complex medical needs, behavioral health needs, activities of daily living (ADL’s) and instrumental activities of daily living (IADL’s) for long term supports and waivers.
Long term services and supports clinical and diagnostic assessments and care planning for members with complex and chronic conditions including performing and arranging for waiver services and personal care assistance.
Refer members to community resources for the appropriate agencies and organizations to enhance and supplement services for the member. Examples: Community Mental Health, Area Agency on Aging, Local Health Departments, Meals on Wheels and Transportation.
Initiates and implements an individual plan of care with attainable goals in conjunction with the member, health care providers, and community agencies. Modifies the plan of care through monitoring and re-evaluation to accommodate changes in treatment or progress for all assigned members.
Care coordination contacts include telephonic and face-to-face interaction with members in their homes, inpatient and outpatient settings, and institutional settings.
Documents the plan of care in accordance with HAP Empowered Policies, NCQA guidelines and Medicare/Medicaid requirements within the Case Management Program.
Performs on-going evaluation of quality and cost effectiveness of Case Management Services.
Documents care in accordance with HAP Empowered Policies.
Maintains statistical data, reports and logs as required.
Works with the Concurrent Review Nurse on evaluations of hospitalized members in need of discharge planning, transitions of care, medication reconciliation, and case management.
Works with the Referral Coordinator to ensure the member receives the correct and cost effective DME.
Interacts with Vendors, Specialists and Primary Care Physicians to authorize and coordinate services for members.
Presents medically complex questionable cases to the Case manager and/or Medical Director for review.
Assures maintenance and sharing of records, reports and assures HIPPA compliance.
Assists the Manager of Government Programs with Case Management Program planning, development, implementation and evaluation.
Attends identified Plan Committee and Staff Meetings.
Other duties as assigned.
Bachelor’s degree in Social Work or Registered Nurse with an Associate’s degree in Nursing.
Master’s degree in Social Work, preferred.
Minimum of two (2) years of case management experience in inpatient and outpatient medical care, long-term care, managed care, home health care, behavioral health settings.
At least two (2) years of experience in waiver or long-term support services settings, preferred.
Medicaid/Medicare and/or HMO experience (Managed Care experience), preferred.
Experience with electronic health and case management systems, preferred.
Participate in Performance Measurement Criteria by: cost reductions, admission statistics, accuracy of data, and accuracy of interpretation of concurrent reviews.
Self-starter who is analytical, organized, intuitive, and investigative.
Good written and interpersonal communication skills.
Strong problem-solving skills, extensive telephone involvement and Care Management coordination.
Manual dexterity to operate PC (MS Word, Excel).
Excellent customer service.
Knowledge of medical terminology and ICD-9 and CPT coding.
Follows State and Federal HMO regulations as related to Utilization Management.
Must have an active State of Michigan license in good standing and without prior or current restrictions as Licensed Bachelor’s Social Worker (LBSW), Licensed Master’s Social Worker (LMSW), Limited Licensed Master’s Social Worker (LLMSW), or Registered Nurse (RN).
Michigan Driver’s Licenses without restrictions.
Have regular access to a registered vehicle with no fault insurance coverage in your name.
Certified Case Manager, preferred.
Qualified Mental health Professional (QMHP) certification, preferred.
Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Whether it’s offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it’s all about choice. Henry
Ford Health has a new approach for its employee benefits program – My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning – options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee’s 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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