Case Manager

Job Description

Job Description

Case.Manager.RN.fy26.revised.4.26.docx

Job Summary: 

This position assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet a patient's needs using communications and available 

resources to promote quality, cost-effective outcomes. This position promotes the efficient and effective use of a variety of health care resources by focusing on the whole 

patient to provide a seamless continuum of care and care management for Oyate Health Center (OHC) patients. 

 

Essential Functions: 

• Understands key concepts including same-day access, continuity of care, empanelment, and integrated care. 
• Works effectively in a rapidly changing and innovative health care system. 
• 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 records and referrals; Ensure validity of registry and collaborate with Information Technology on registry functionality. 
• Maintain a tracking system for patient care coordination and care management across the continuum, including transitional care management, tracking referred patients for admission to other healthcare facilities; performs chart reviews to determine timeliness of requested service to facilitate the discharge of patients currently admitted to outside facilities. 
• Monitor CHEF program for CHS department and other programs, including case reviews and assures documentation is prepared and submitted timely for reimbursement. 
• Conduct a comprehensive assessment of patients’ physical, mental, and psychosocial needs; Collect in-depth information about a person's situation and function to identify needs 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. 
• Responds to insurance providers and third-party agencies to ensure maximum reimbursement to minimize cost on clinical issues.
• 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, 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. 
• Initiates 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
• Assists with referrals and/or follow-up care based on with referrals and/or follow-up care based on recommendations by the outside facility medical providers patients have been referred to or as ordered during discharge from an inpatient facility.
• Utilizes skills in prioritizing needs, problem-solving, and decision-making in a clinical setting.
• Efficiently and effectively manages multiple responsibilities. 
• Responds to life-saving situations based upon nursing standards, policies, code procedures, and established protocol.
• Participates in Quality Assurance activities such as GPRA, PI, IPC, audits/peer review, discharge planning, and infection control.
• Must comply with federal laws and regulations as required by the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act (HIPPA).
• Coordinates and leads multidisciplinary patient care conferences for high-risk or complex patients as needed. 
• Functions as the liaison between referral providers and Oyate Health Center Providers in regard to declined referrals. 
• Participates in department and system wide committees. 
• Provide ongoing evaluations and documentation of patient progress/risk status and communication with the care team. 
• Performs job and other related duties as assigned by the supervisor with minimal supervision. 

Physical Requirements

This position requires prolonged sitting with frequent use of a computer and standard office equipment. Occasional standing, walking, and travel between locations or client sites may be required. The employee must be able to lift up to 25 pounds and perform routine tasks involving reaching, bending, and handling materials. Visual acuity is required for reviewing detailed documentation and electronic records. The employee must be able to communicate effectively, including speaking clearly and hearing and understanding clients and team members. Work is performed in office, clinical, and community environments and may involve managing multiple priorities and emotionally complex situations.

Required Qualifications

• 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 .