CHS Care Case Manager - RN - Clinic - Tulsa

MINIMUM QUALIFICATIONS Education – A Bachelor’s Degree in Nursing (BSN) received from an accredited school of professional nursing is preferred. 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 – Valid 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 Department of Health 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 clinic office, though some travel may be required throughout the MCNDH and among the various health care providers utilized by the MCNDH. ESSENTIAL FUNCTIONS Satisfactory job performance will be determined by successful execution of the following: Responsible for providing adequate documentation and information to the patient. Prepare transitions of care after referral is written for patient. Serve as a patient resource. Consult with Chief Medical Officer (CMO) and other members of the CHS team if necessary to facilitate correct decision-making regarding medical priority in the patient’s care. Responsible for approving referrals on the spot after Primary doctor writes a referral that falls within the medical priority guidelines. Arrange for consultations with patients and family members and provide them individual guidance and education regarding the CHS process. 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 MCNDH 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. Provide a proactive approach for reviewing patients’ s clinical needs and the resources needed to access care. Responsible for improving information flow between the patient, I/T/U Primary care providers and outside facilities for positive outcomes for our patients we serve.