POSITION TITLE: Manager- Medical Case Management

CLASSIFICATION: Exempt

DEPARTMENT: Tribal Health

SUPERVISOR: Director of Nursing or Designee

GRADE: E17 $79,692.29 ($38.31) - $119,615.36 ($57.51)

Position Summary:

The Manager of Medical Case Management will be responsible for performing a full range of nursing tasks for the medical clinic in a variety of settings, working with a diverse group of patients and care providers. The Medical Case Manager will exercise full professional discretion and technical judgment based on licensure. Work is performed under the general direction of the Director of Nursing. This position requires consistent, sound judgment and the ability to work independently with minimum direct supervision. The Medical Case Manager will work within the context of standing orders and protocols.

Essential Duties & Responsibilities:

• Responsible for serving as Case Manager for patients with chronic illness’ and/or other health conditions. Duties to include but are not limited to: maintaining an accurate registry, coordinating referrals/follow up, and assisting in a multi-disciplinary case management process.
• Process, schedule and track all referrals to outside providers for medical clinic patients. Work directly with PRC staff on PRC eligible referrals and schedule patient transportation through the transportation coordinator.
• Work directly with patients to determine the best times and dates for their referral appointments. Notify patients by phone or mail, of scheduled appointments and explain details of appointments and any requirements.
• Under the direction of clinical providers: review labs, diagnostic tests, consult letters, prior authorizations, prescription refills and coordinate follow-up activities for patients. Must coordinate records with outside providers, ensuring the medical records, treatment plans, tests and/or summary etc. are submitted to WTHC for review by primary care provider.
• Must review hospital emergency room, admittance, or discharge reports as necessary. All records should be submitted to primary care provider for review, and assist provider/patient with ongoing treatment needs.
• Maintain accurate, complete, timely and professional documentation in all medical records. Documentation of all patients contacts required; including but not limited to telephone calls, nursing visits and/or any significant changes for provider to review.
• Work as a team with the Chief Medical Officer, Physicians, Family Nurse Practitioners, and other Nursing Staff in making decisions which affect patient care and/or other clinic staff members.
• As per established protocol Nurse will provide telephone and office triage; including conducting initial health assessment and identifying chief complaint, existing health problems, and health maintenance needs for all patients. Nurses will coordinate with medical providers of patient care needs.
• Assist with the development and review of medical clinic and nursing related policies and procedures in accordance with evidenced based practice, federal and state regulations, and/or accreditation standards.
• Assist in the development and implementation of the WTHC Quality Improvement Program, as assigned. Apply knowledge and experience with preparation for regulatory and/or accreditation review or inspections.
• Assist with the accurate data entry, tracking and reporting of all statistics for federal, state, I.H.S. and/or grant requirements, including but not limited to immunization reports, GPRA, IHS reports, and AAAHC standards; as assigned.
• The incumbent will be called upon to accomplish other tasks within their scope of work.

Requirements

Minimum Qualifications:

• Required to possess a current State License as a Registered Nurse. For out of state applicants; Nevada Registered Nursing Licensure required within 90 days of hire. (Must submit copy of Licensure with application.)
• Required to have a minimum of three (3) years’ experience working in an outpatient or ambulatory care clinic setting.
• Required to acquire and maintain BLS and ACLS certifications within 90 days of hire.
• Required to submit to PPD testing and adhere to WTHC staff immunization policy.
• Required to accept the responsibility of a mandatory reporter of abuse and neglect of infants and children, people who are elderly or dependent, individuals with mental illness or developmental disabilities or residents of nursing homes and other health care facilities. This includes reporting any evidence of physical injury, neglect, sexual or emotional abuse or financial exploitation.
• Positive working experience with Native Americans in a related field will be given preference.
• Preference will be given to qualified Native Americans.

Knowledge, Abilities, Skills, and Certifications:

• Knowledge of and the ability to interpret regulatory and accreditation standards. Knowledge of nursing theory and practice.
• Ability to coordinate referral activities; work well under pressure and demands for time.
• Knowledge of out-patient or ambulatory clinic policies and procedures.
• Knowledge of health care provider operating techniques.
• Ability to identify medical priorities of patient care and telephone triage, including stat referrals and follow up.
• Ability to effectively work with the public, co-workers, and supervisors; which includes communicating effectively both verbally and in written form.
• Possess the tact necessary to work effectively with patients, physicians and other employees.
• Must have ability to complete required documentation and required written follow-up. Teamwork skills a must.
• Demonstrate proficient computer skills for data entry, scheduling and other related duties.
• Demonstrate ability to accurately maintain records and/or a filing system.
• Ability to maintain strict confidentiality of medical records and adhere to the standards for health record-keeping, HIPAA and Privacy Act requirements.

ACKNOWLEDGEMENT:

This position description is intended to provide an overview of the requirements of the position. It is not necessarily inclusive and the job may require other essential and/or non-essential functions, tasks, duties, or responsibilities not listed herein. Nothing in this job description, or by the completion of any requirement of the job by the employee, is intended to create a contract of employment of any type.

Physical Demands:

While performing the duties of this job, the employee regularly is required to sit and stand; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to walk. The employee occasionally is required to operate a motor vehicle; stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 50 pounds.

Work Environment:

Work is generally performed in a clinical setting with a moderate noise level.

The Washoe Tribe of Nevada & California requires a background check of each new hire for employment purposes. Therefore, all conditionally offered positions will be subject to the following:

• Negative alcohol and drug screen
• Meet requirements of Public Law 101-630
• Obtain or possess a valid driver’s license for either the state of Nevada or California within 30 days
• Must be insurable under the Washoe Tribe’s driving policy