Care Manager

Mary Free Bed is a not-for-profit nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient outpatient sub-acute rehabilitation orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation Mary Free Bed physicians nurses and therapists help our patients achieve outstanding clinical growing Mary Free Bed Network provides patients throughout the system with access to our unique standard of care.

Mission Statement

Restoring hope and freedom through rehabilitation.

Employment Value Proposition

At Mary Free Bed we take pride in our values-based culture:

• Focus on Patient Care. A selfless drive to serve and heal connects all MFB employees.
• Clinical Variety and Challenge. An inter-disciplinary approach and a top team of professionals create ever-changing opportunities and activities.
• Family Culture. We offer the stability of a large organization while nurturing the family/team atmosphere of a small organization.
• Trust in Each Other. Each employee knows that co-workers can be trusted to make the right decision for our family patients staff and community.
• A Proud Tradition. Years of dedicated quality service to our patients and community have yielded a reputation that fills our employees with pride.

Age Specific Responsibility

Must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in assigned department. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patients status and interpret the appropriate information needed to identify each patients requirements relative to age-specific needs and to provide the care needed as described in the departments policies and procedures.

Summary

Provides care management services to all patients and families to promote optimal functioning throughout the rehabilitation process. Maintains current with clinical practice through continuing education research and program development.

Essential Job Responsibilities

• Provide patient care treatment and services within the scope of their license certification or registration and as required by Federal and State laws and regulations.
• Provides care management services to patients and families.
• Provides an initial psychosocial assessment of patient and family functioning adjustment to disability health literacy status and coping skills.
• Provides education to facilitate adjustment problem solving and the development/implementation of an appropriate discharge/transition plan.
• Communicate with patients and families/supports to promote participation in the development and execution of the plan of care.
• Acts as an internal case manager and functions as liaison with external case managers providers and funding sources to maximize patient satisfaction quality and cost-effective outcomes.
• Coordinates highly effective level of care transitions from inpatient to community-based levels of care and services such as: outpatient rehabilitation home care hospice school vocational rehabilitation counseling etc.
• Oversees the patient follow up process to insure highly durable outcomes.
• Documents patient/family status progress and discharge status through initial evaluation progress notes and discharge summaries according to established time standards.
• Identify and remove barriers to the discharge/transition process by:
  • Identifying complex discharge/transition needs early on to assist the patient and family/supports in acquiring resources such as: non-covered medications home modifications non-funded equipment etc.
  • Ensuring access to all needed follow-up primary care and medications at discharge which may include assistance in locating funding to reduce the likelihood of re-hospitalization.
  • Educate patients and families/supports on current evidence-based practices related to complex /chronic disease management across the continuum of care to reduce the frequency of re-hospitalization.
  • Communicates with rehabilitation team regarding patient and family needs preferences resources funding issues and discharge/transition status to integrate the care process and minimize fragmentation in the services.
• Attends and leads in-patient team conferences by representing the needs preferences and resources of the patient and family/supports. Identify the need for and facilitate family conferences as appropriate to assure the needs and preferences of the patient and family/supports are in unison with the goals and clinical interventions of the rehabilitation team.
• Functions as a patient advocate and maintains patient confidentiality. Educate the patient the family/supports and members of the health care delivery team about treatment options community resources insurance benefits psychosocial concerns case management etc. so that timely and informed decisions can be made.
• Promote patient self-advocacy choice and self-determination. Educate patients and families/supports in the appropriate use of health care services. Improve quality of care and maintain cost effectiveness on a case-by-case basis.
• Provides discipline specific coverage within the Mary Free Bed System as requested.
• Participates in orientation and training of new staff.
• Supervises student internships as appropriate.
• Supports program operations as assigned.
• Leadership Must-Haves will be followed for patient and staff interactions:
• Rounding
• Thank You Notes
• Employee Selection/Peer Interviewing
• Key Words at Key Times
• AIDET Promise
• Standards of Behavior

Customer Service Responsibilities

Demonstrate excellent customer service and standards of behaviors as well as encourages coaches and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.

Responsibilities in Quality Improvement

Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.

Essential Job Qualifications

• Education:
  • If applying as a Registered Nurse: Minimum Associates degree in nursing from an accredited institution.
  • If applying as a Social Worker/Counselor: Masters degree in social work Counseling or related field from an accredited institution.
• Licensure:
  • If applying as a Registered Nurse: Must hold an active RN license in the State of Virginia.
• Minimum of 3 years of experience in care management or related role within a healthcare setting.
• Demonstrated expertise and competence in a specialized area of clinical practice relevant to the care management role.
• Ability to work effectively within a multidisciplinary team to coordinate patient care and support services.
• Strong commitment to delivering compassionate culturally sensitive and patient-focused care.
• Excellent verbal and written communication skills with the ability to engage patients families and healthcare professionals.
• Effective time management and organizational skills. Function in a self-directed manner. Ability to make quality collaborative decisions in short timeframes.
• Strong analytical and problem-solving abilities; able to perform effectively under pressure manage high volumes and adapt to frequent interruptions.

Preferred Job Qualifications

• Experience working in acute rehabilitation.
• Experience in interdisciplinary team management.

Physical Requirements for Essential Job Qualification

Levels:

• None (No specific requirements)
• Occasionally (Less than 1/3)
• Frequently (1/3 to 2/3)
• Majority (More than 2/3)

Remain in a stationary position: Majority

Traverse or move around work location: Occasionally

Use keyboard: Frequently

Operate or use department specific equipment: None

Ascend/Descend equipment or ladder: None

Position self to accomplish the Essential Functions of the role: None

Receive and communicate information and ideas for understanding: Frequently

Transport position and/or exert force:

Up to 10 pounds: Occasionally

Up to 25 pounds:

Up to 50 pounds:

Up to 75 pounds:

More than 100 pounds:

Other weight: Up to pounds

Other:

Compensation based on experience starting from $32.05.

Consistent with the Americans with Disabilities Act (ADA) it is the policy of Mary Free Bed Rehabilitation Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment including the application process. If reasonable accommodation is needed please contact the Talent Acquisition team at .

Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion gender national origin age genetic information veteran status disability or other legally protected characteristic.

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