Career Opportunities

The Care Manager is a member of the United Physicians Medical Management team and will work collaboratively with the Complex Care Manager. The Care Manager will participate in the process of assessing, coordinating, implementing, communicating, and evaluating patient care to meet an individual’s specific health needs. The Care Manager will promote patient education and self-management using case management methods.

Responsibilities & Duties:

• Accurately identify and stratify patients with chronic disease that would benefit from case management and Identify opportunities for care management services through claims information, pharmacy, hospital admission information, provider referrals, and/or registry information.
• Perform comprehensive assessment of patient and gather information concerning the patient’s health behaviors, clinical influences, and cultural/social beliefs.
• Collaborate with the patient and the multidisciplinary health care team to develop an individualized and evidence based plan of care.
• Communicate directly with patient/family/PCP to incorporate patient’s needs in order to prepare the patient to make informed and appropriate decisions.
• Provide education to patient/family to prevent risk behaviors and promote and achieve positive health and wellness outcomes.
• Engage patients in goal setting to achieve optimal health, and use clinical judgment to assist patients in overcoming barriers to goals.
• Efficiently document assessments, clinical findings, healthy lifestyle, preventive service, self management strategies, plan of care, and evaluate the effectiveness of care plans and progress toward goals.
• Develop reports and collect data on case activity and outcome analysis
• Monitor and document the quality of care which includes:

• Actively promote frequent communication between all team members, providers, patients and their families to enable a smooth transition from one level of care to another to assure quality care is provided during transitions of care (complex care to disease management.)
• Demonstrate self-directed, self-motivated, responsible behavior. Recognize when there is a need for adjustment and flexibility as changes occur in patient activity and workload.
• Demonstrate appropriate judgment skills to be able to make independent clinical decisions in patient care matters.
• Recognize, respect and utilize the special abilities and skills of other professionals.
• Adhere to the scope of practice for Registered Professional Nurse per state regulatory guidelines.
• Respect confidentiality of all persons and follows state, federal and organization policies and procedures.
• Effectively participate on various internal committees and performs other duties as requested by management.
• Miscellaneous duties as assigned.

• Valid unrestricted State of MI Nursing License required.
• Valid State of MI Drivers License.
• Two years case management outpatient/discharge planning.
• BSN preferred
• Paediatric experience preferred.
• Knowledge of clinical criteria/guidelines for preventive services and chronic disease management.
• Knowledge of current medical procedures/practices, case management guidelines and their application, disease processes and disease population management.
• Home health nursing experience background is a plus.
• Knowledge of community resources also a plus.

Performance Skills:

• PC literate with MS Office skills preferably Excel.
• Excellent written, verbal and interpersonal skills required.
• Problem solving, analytical, and decision making skills.
• Planning and implementation skills.

Responsibilities & Duties:

• Provide nutritional assessment, education, and management to clients referred by physicians.
• Develop and deliver educational programs and appropriate teaching tools for various ethnic and cultural groups to support understanding of nutrition.
• Provide instruction to clients in the use of modified diets as it relates to health promotion and chronic conditions.
• Coordinate, implement, and evaluate nutritional education using National standards and guidelines.
• Provide outpatient and community based education and counselling to patients and families, individual or group, in accordance with established educational plans.
• Prepare nutrition related presentations and present them to various audiences.
• Perform other duties as assigned.

Qualifications:

• Bachelor's degree with course work approved by the American Dietetic Association's Commission on Accreditation for Dietetics Education.
• Passed a national examination administered by the Commission on Dietetic Registration.
• Must have experience working with the pediatric population.
• Knowledge of nutrition guidelines in chronic disease management.
• Proven experience interacting with physician practices.
• Ability to work independently.
• Excellent written and verbal communication.

Performance Skills:

• PC literate with MS Office skills preferably Excel.
• Excellent written and verbal communication.
• Knowledge of Microsoft Office Products (Word, Excel, PowerPoint).
• Ability to interact effectively with all levels of the organization and key external audiences.

Responsibilities & Duties:

• Provide Diabetes management, education, and counselling to clients referred by physicians.
• Provide outpatient and community based education and counselling to patients and families, individual or group, in accordance with established treatment/educational plans.
• Develop and deliver diabetes educational programs and appropriate teaching tools for various ethnic and cultural groups to support understanding of Diabetes Management.
• Provide instruction to clients in the management of Diabetes.
• Coordinate, implement, and evaluate diabetes education using national Standards and guidelines.
• Create project plans for clinical initiatives identified by health plans.
• Prepare diabetic related presentations and present them to various audiences.
• Perform other duties as assigned by Vice President.

Qualifications:

• Certification as a Diabetic Educator.
• RN Licensure required.
• Must have at least two years previous diabetes education experience.
• Proven experience interacting with physician practices.
• Knowledge of medical terminology.
• Ability to work independently.
• Excellent written and verbal communication.

Performance Skills:

• Knowledge of Microsoft Office Products (Word, Excel, PowerPoint).
• Excellent interpersonal communication skills.
• Ability to interact effectively with all levels of the organization and key external audiences.