Case Manager- ED/IP/Chronic Care Nurse Navigator
Company: HAMILTON COMMUNITY HEALTH NETWORK
Location: Flint
Posted on: June 25, 2022
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Job Description:
Job DetailsJob LocationAdministration - Flint, MIPosition
TypeFull TimeEducation Level2 Year DegreeTravel PercentageNoneJob
ShiftAnyJob CategoryHealth CarePosition Summary This position is
responsible for providing case management and outreach services to
patients in alignment with the goals of the ED/IP/Chronic Care
Navigation and Readmission Diversion program.General
responsibilitiesUse Health Information Exchange (Azara) to
implement a Utilization Review process to identify patients who are
in the hospital or visited the ED or have over-utilized the
ED.Follow-up with patients to establish a primary care provider
within the HCHN system and assure a follow-up visit following
discharge.Provides Transition of Care collaboration between health
care organizations and documents services.Identify patients with
chronic care conditions to be managed through an established
chronic care model at HCHN and assist in closing gaps in
care.Completes medical assessment/history and fall assessment for
each client including medication reconciliation and develops a
documented plan of care for each clientProvides health education
related to the condition and assists with the coordination of care
for patients as directed by the healthcare providers and related to
the patient's needs.Analyzes patient/family assessment data with
respect to physical, psychosocial, educational, and all other
needs.Completes an assessment of patient/family needs with respect
to physical, psychosocial, educational, and all other
needs.Evaluate patients response to care through
observation.Assesses patients with respect to specialized needs,
social determinants of health and assists with navigation through
the health care system.Assist patients with development and
follow-through for self-management goals.Assists patients entering
substance abuse or other chronic care maintenance programs.Serves
as a resource for the health team, patient, and family.Advises and
makes recommendations to providers, patients, and families
regarding the availability of resources and coverage locate the
resources, and arrange for the provision of cost-effective services
for patients.Assesses patients resource status and seeks out
alternatives when coverage is not available.Ensures referrals to
the CHW, Insurance navigator, or DHS worker for patients that are
eligible for state funding or programming.Maintains a panel of
patients served that includes all support services and efforts made
to resolve issues of care.Prepares reports for contacts and
navigation effortsOther duties as assigned.Education and/or
ExperienceNursing degree from an accredited school of nursing or a
bachelors degree in social work, sociology, or psychology, or
related field is required.Current State of Michigan nursing
licenseMinimum of two (2) years professional experience CPR
certificationTwo years of case management experience
preferred.QualificationsTo perform this job successfully, an
individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of
the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions.Excellent interpersonal and
customer service skills, to effectively and tactfully deal with a
diverse group of patients, staff, customers, and community
groups.Ability to maintain confidentiality in all matters.Flexible,
with the ability to work independently and with minimal guidance.
Strong oral and written communication skills. Ability to type 40
wpm.General computer proficiency.Ability to communicate effectively
with diverse populations.Physical Demands The physical demands
described here are representative of those that must be met by an
employee to successfully perform the essential functions of this
job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.While
performing the duties of this job, the employee is regularly
required to talk or hear. The employee may be required to stand,
walk, sit for long periods of time; use hands to handle or feel;
reach with hands and arms; and stoop, kneel, or crouch. The
employee must occasionally lift and/or move up to 25 pounds.
Specific vision requirements include the ability to see at close
range. At times, may require more than 40 hours per week to perform
the essential duties of the position. Fine hand manipulation
(keyboarding).Travel between sites using own vehicle.Work
Environment The work environment characteristics described here are
representative of those an employee encounters while performing the
essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the
essential functions. Internal office space. The noise level in the
work environment is usually moderate.May be exposed to communicable
diseases.
Keywords: HAMILTON COMMUNITY HEALTH NETWORK, Flint , Case Manager- ED/IP/Chronic Care Nurse Navigator, Healthcare , Flint, Michigan
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