Case Manager

REPORTS TO CLINICAL BEHAVIOR HEALTH SERVICES Job Summary: The Case Manager aids in implementing program objectives and deliverables and provides case management services to enrolled participants. Essential Functions Identify cases with potential for high‑risk complications; act as an advocate for an individual's health care needs; understand methods for assessing an individual's present level of physical/mental impairment; assist individuals with the development of short‑ and long‑term health goals; understand the psychological characteristics of wellness. Manage OHC high‑risk patient registry; oversee systems for identifying high‑risk patients through electronic health record and referrals; ensure validity of registry and collaborate with Information Technology on registry functionality. Develop and maintain a tracking system for patient care coordination and care management across the continuum, including care transitions, primary and specialty care, tracking referred patients for admission to other healthcare facilities; perform chart reviews to determine timeliness of requested service to facilitate the return of patients. Provide technical assistance to CHS staff for clinical issues for their assigned patients. Respond to insurance providers, third‑party agencies to insure maximum reimbursement to minimize cost on clinical issues. Implement and monitor CHEF program for CHS department, including case reviews and assure documentation is prepared and submitted timely for reimbursement. Conduct comprehensive assessment of patients’ physical, mental, and psychosocial needs; collect in‑depth information about a person's situation and functioning to identify needs in order to develop a comprehensive case management plan that will address those needs. Develop care plans to prevent disease exacerbation, improve outcomes, increase patient engagement in self‑care, decrease risk status, minimize hospital and emergency room utilization, and are obtainable and concise with the patient needs and goals. Utilize behavioral strategies to help patients adopt healthy behaviors and improve self‑care in chronic disease management; promote self‑management goals. Assist patients in navigating the health care system; coordinate specialty care, follow up on test results and other care coordination needs; execute specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan. Partner with external case management programs to coordinate care. Provide ongoing evaluation and documentation of patient progress/risk status and communicate with care teams. Gather sufficient information from all relevant sources about the case management plan and its activities and/or services to enable the case manager to determine the effectiveness of the plan. Record accurate, timely and appropriate information in the patient’s electronic health record; document observations, nursing interventions, therapeutic measures administered and status of coordinated activities between nursing and other professional disciplines. Initiate a patient education plan according to the individualized needs of the patient, as prescribed by medical provider and/or OHC policy, including patient and family instruction; notify patient of lab results and provide advice to patients per provider instruction. Assist with referrals and/or follow up care based on results of laboratory and radiology reports, and the mental health and well‑being of the patient as recommended by the medical provider. Respond to life‑saving situations based upon nursing standards, policies, code procedures, and established protocol. Participate in quality improvement activities such as GPRA, PI, IPC, nursing audits/peer review, infection control, case management and nursing care conferences. Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA). Perform related duties. Requirements Participate in Core Connections training and apply GPTLHB Core Connections concepts and practices in their work. Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors, and guests. Foster a work environment of wellness, courtesy, friendliness, helpfulness, and respect. Relate well and work collaboratively with coworkers and all levels of staff in a professional manner. Familiarity and/or experience working with American Indian populations and respect for and knowledge of traditional, cultural, and spiritual practices of diverse American Indian communities, as well as an ability to work with other culturally and ethnically diverse populations. Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities. Maintain and ensure organizational privacy and confidentiality. Must be able to handle crisis and tolerate stress professionally. Must be self‑directed and take proactive initiative to assist others. Possess the ability to resolve issues with other departments and coworkers without direct supervision. Able to exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment. Ability to maintain a flexible work schedule, including evenings, weekends and overnight or extended travel as necessary. Ability to effectively present information in one‑on‑one and small group situations to community members, consumers, and other employees of the organization. Proficiency with computer programs (Word, Excel, PowerPoint) and other Internet technologies. Valid driver’s license must be kept current, and certificates, credentials or licenses must be kept current and consistent with regulations required by applicable federal, state and/or grant regulations. Ability to promote an alcohol‑, tobacco‑ and drug‑free lifestyle. Embrace modes of appearance and attire that reflect a professional presence. Adhere to GPTLHB policies and procedures. Additional Requirements Bachelor’s degree, or associate’s degree and three (3) years’ experience. Licensed as a Registered Nurse. Documented case management and/or administrative experience preferred. The GPTLHB is a tribal organization that follows tribal preference laws. Our policy is to give preference to qualified Indian/Tribal candidates over qualified non‑native candidates in hiring decisions if all other qualifications are equal. Employment is contingent upon the outcome of all required criminal background checks. Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job‑related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella), Varicella (Chicken Pox), Hepatitis B, Influenza, T‑dap (Tetanus – Diphtheria – Pertussis), and COVID‑19 vaccination is required. #J-18808-Ljbffr