Medical Case Manager

Job Description

Job Description

Position Description

Medical Case Manager

Position Summary:

Under the direction of the Medical Director. The Medical Case Manager role involves coordinating and providing care that is safe, timely, effective and efficient, equitable, and client-centered. The responsibilities include monitoring and ensuring that patients are provided with appropriate care as well as coordinating communication and case management between team members, patients, and other health care professionals.

Essential Duties and Responsibilities:

1. Evaluating the medical needs of the patient and coordinating a comprehensive communication of their care plan.
2. Coordinating with healthcare providers to ensure the patient(s) is receiving necessary treatments and services.
3. Monitoring and assessing the effectiveness of the care plan and making necessary adjustments as directed by physicians.
4. Advocating for patients and their families, ensuring they understand the patients conditions, treatment options, and resources available, and their rights pertaining to their care.
5. Ensuring all medical records are maintained and updated with accurate information, dates of care, health insurance etc.
6. Communicating with insurance companies about coverage and cost, referrals to internal departments and other agencies.
7. Helping patients access necessary resources such as finding specialists or scheduling appointments.
8. Educating patients and their families about how to navigate their resources and promoting healthy lifestyle choices about keeping appointments with care providers.
9. Addressing any concerns or complaints from the patient or their family and submitting or assisting with processing forms.
10. Complying with all healthcare laws, regulations, and standards.
11. Coordinate patient care between various departments of our healthcare team including external collaborative partners.
12. Ensure patients receive the necessary services and care timely and expeditiously.
13. Document patient case information within a database system, electronic health records (NexGen).
14. Participate in care plan, quality improvement and quality assurance logistics.
15. Facilitate multiple care aspects (case coordination, information sharing, etc.).
16. Ensure compliance with healthcare regulations and safety standards and file forms, reports and certificates.
17. Answers phones, greets patients, and schedules appointments and set reminders.
18. Perform general office duties or other responsibilities as needed and assigned by team, Manager or Medical Director.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed here are representative of the knowledge, skills, and/or abilities required. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills, and Abilities

1. Extensive knowledge of the healthcare system and the procedures for patient care and treatment.
2. Excellent decision-making skills to evaluate and manage the health conditions of different patients.
3. Strong communication skills to liaise between patients, healthcare professionals, and insurance companies.
4. Ability to provide medical guidance and education to patients and their families about treatment options and care plans.
5. Exceptional organizational skills to maintain accurate and detailed medical records, and monitor patient progress effectively.
6. Compassionate interpersonal skills to empathize with patients and provide emotional support when necessary.
7. Problem-solving skills to identify potential issues and develop effective solutions to ensure the best patient outcome.
8. Ability to work in a multidisciplinary team and collaborate with various healthcare professionals.
9. Strong understanding of medical terminology and medical insurance policies.
10. Must have good communication skills, be able to effectively communicate with diverse populations, and be willing to convey responsibilities to patients.
11. Demonstrate the ability to work independently in carrying out assignments while remaining reliable and dependable.
12. Demonstrate professional competency in office and healthcare abilities, including the maintenance of client confidentiality.
13. Ability to demonstrate basic levels of computer literacy, with a functional understanding of Microsoft Windows Operating Systems in an office setting, and demonstrate a working knowledge of routine office hardware and equipment (e.g. printers, copiers, fax machines, etc.).
14. Must be familiar with entering data into a healthcare database program (NextGen).
15. Must demonstrate the ability to maintain accurate records and preparing clear and accurate reports for informational, auditing, and operational use, including capacities for attention to detail and for reviewing and verifying accuracy of data.
16. Possess the ability to organize and follow one’s own work schedule (i.e. setting priorities, being available during work hours, and meeting critical deadlines).
17. Possess the ability to perform well in group problem-solving situations and use reason even when dealing with highly emotional topics.
18. Possess the ability to become knowledgeable of health needs and services provided to the Indian community both on and near the reservation.
19. Demonstrate the competency and integrity to maintain the confidentiality of organizational, employee, and client records.
20. Possess the ability to deliver effective training and presentations on technical subjects to large and/or small groups of various educational and cultural backgrounds.
21. Possess knowledge of federal, state and local laws and regulations governing public health, principles of mental health. Laws and regulations relating to the practice of medicine and nursing.
22. Knowledge of causes, means of transmission and methods of control of communicable disease, principles and practices of diagnosis and treatment of common medical problems, child growth, and development.

Education and/or Experience

1. Associates Degree with relevant experience
2. 3-5 years of experience in healthcare setting.

Certificates, Licenses, Registrations

1. Possess a current California driver’s license, and be insurable with the Tule River Indian Health Center, Inc. insurance agency.
2. First Aid/CPR at BCLS level.
3. Certified Case Manager Certification-preferred

Preferred Qualifications and Contingencies

1. Significant leadership experience.
2. Previous experience in case management, including patient advocacy, coordinating care, and dealing with insurance companies
3. Work under pressure, make critical decisions, and deal effectively with various healthcare professional, patients, and their families
4. TRIHCI maintains a drug- and alcohol-free workplace, and all offers of employment are contingent on the successful completion of a criminal background check, a post-offer drug test and physical and TB test, and verification of each candidate’s right to work in the United States.

Hiring preference is given to qualified American Indians in accordance with the Indian Preference Act (title 25, U.S. code § 472 & 473). Applicants claiming Native American/ Indian Preference must submit Indian verification, certified by Tribe of affiliation or other acceptable documentation of Native American/ Indian heritage.

Physical Work Environment: The description provided here is representative of those conditions in which the Medical Case Manager will be required to perform the essential functions of this position. As stated earlier, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

While performing the duties of this position, the Medical Case Manager is situated in a standard office environment within the health center, where there is little or no exposure to variations in the weather or other similar elements. The Medical Case Manager will move throughout the health center to meet with supervisors and co-workers, but maintains direct patient/client contact. Consequently, the Medical Case Manager must:

1. Possess the mobility to work in a standard office setting (i.e. walk, stand, or sit for extended periods of time);
2. Possess the ability to use standard office equipment to write, type, copy, fax, or perform other duties;
3. Possess the strength to lift and carry supplies weighing up to 15 lbs. repeatedly and up to 45 lbs. intermittently;
4. Possess the visual acuity to read printed materials and a computer screen; and
5. Demonstrate hearing and speech capabilities that allow him/her to communicate in person and over the telephone as required,
6. Possess the ability to push, bend and/or lift to help patients to/from vehicle, wheelchairs, stretchers, etc., and moving equipment and medical supplies.

The clinical setting at TRIHCI is categorized by OSHA as a Blood-borne Pathogen Category I facility. Consequently, there exists the potential for exposure to blood, body fluid/tissue, and infectious wastes. There also exists the potential for exposure to chemicals, biologicals, toxicants, and irradiants found on-site.