CHS Care Case Manager - LPN - Clinic - Coweta

MINIMUM QUALIFICATIONS Education – A licensed practical nurse (LPN) received from an accredited school of professional nursing is preferred or a vocational practical nursing program. Candidates who have graduated from an associate’s degree program or other program of at least two (2) years in a nursing curriculum may be considered. Experience – A minimum of one (1) year related experience in a relevant job position. Licenses & Certification - Must possess current State of Oklahoma Nursing License. Knowledge & Skills – Knowledge of all aspects of Contract Health Services in a tribal PL 93-638 environment. Knowledge of IHS and Health System policies and procedures related to CHS. Knowledge of acceptable standards of nursing practices, principles and theories. Knowledge of the Privacy Act and other related regulations with regards to confidentiality and the release of medical information. Ability to communicate and interact effectively with patients and their families, staff members, other employees, tribal officials and the public both orally and in writing. Knowledge of patient teaching/counseling techniques. Knowledge of regulations regarding pre-certification, etc., of various insurance companies. Ability to communicate and accept varied lifestyles, healing methods and practices. Knowledge and skill to utilize a PC in a Windows environment and to operate other necessary office equipment. Ability to communicate courteously and effectively with administrative and medical staff, patients and their families, Tribal and Non-Tribal health care professionals and the general public both orally and in writing. JOB SUMMARY The purpose of this position is to facilitate and expedite CHS referrals throughout the Muscogee (Creek) Nation Health System by providing day-to-day management for individual patients within the CHS system. WORK ENVIRONMENT Work is performed in an ambulatory healthcare setting, though the work may include a certain amount of exposure to hostile and emotionally disturbed patients. PHYSICAL DEMANDS Work requires the demands of normal office, though some travel may be required throughout the MNHS and among the various health care providers utilized by the MNHS. ESSENTIAL FUNCTIONS Satisfactory job performance will be determined by successful execution of the following: Responsible for conducting diagnostic chart reviews of each request (Referral and Call-in) received from the ambulatory clinics. Make initial decisions regarding categorization under the medical priority system based upon the diagnostic chart reviews. Consult with the supervisor, the Chief Medical Officer (CMO) and other members of the CHS team as necessary to facilitate correct decision-making regarding cases which do not clearly fall within the guidelines of the medical priorities. Facilitate weekly meeting with the CMO and other members of the CHS management team as necessary to discuss issues regarding individual referrals and other questions which arise during the course of review. Arrange for consultations with patients and family members and provide them individual guidance and education regarding the CHS system. Facilitate patient and family understanding of the policies and procedures of the CHS System and coordinate the movement of patients through the system. Prepare treatment and discharge plans for individual patients where indicated. Provide utilization reviews to ensure that services available within the MNHS are utilized whenever possible before making referrals outside the system. Consult with the referring physician if services are not available to prepare alternate treatment plans based on patient history. Regular attendance is required. Performs other duties as required. Provide transition of care services. Serve as a patient resource.