Nurse Case Manager RN
Job Description
Job Description
This position is located at Haak’u Health Center, Purchased and Referred Care (PRC) Department, Acoma Pueblo, NM. The incumbent serves under the general supervision of the Chief Nurse Executive (CNE) with oversight from the Supervisor of the PRC program; coordinating care between urgent and outpatient care teams, outside entities, and PRC; and delivery of direct case management services in conjunction with other outpatient case management and clinical practice managers.
Case management promotes the efficient and effective use of a variety of health care resources by focusing on the whole patient to promote access to a seamless continuum of care. The goals are to promote quality patient centered care; decrease the fragmentation of care; and to ensure care is timely, appropriate, cost effective, sensitive, and coordinated. The incumbent primarily works weekdays, Monday through Friday, however, may be required to work weekends and some federal Holidays and is subject to call back.
MAJOR DUTIES AND RESPONSIBILTIES
Serves as clinical liaison and resource for the PRC staff for clarifying provider referrals/orders; assisting with the care coordination of ordering complex durable medical equipment (oxygen, power wheelchairs, scooters), and care managing mostly un-resourced patients/referrals but may include some resourced patients/referrals.
Facilitates communication with clinical staff, and partners with the clinical care teams to ensure referrals are appropriate and timely.
Serves as the team lead for the outpatient case management and PRC referral database. Ensures the tracking processes of referrals are appropriate and meet patient centered medical home guidelines.
Co-manages patient care needs with outside agency case managers and/or social works of hospitalized (primarily complex medical, surgical, pediatric, obstetric, gynecologic, trauma, and psychiatric patients) who utilize HHC as their primary care network.
Works with referral vendors and other partners to ensure referral processes are appropriate and timely.
Manages and triages case management consult requests for all ambulatory clinics, including local tribal service units.
Attends PRC Committee meetings as a resource for Medical Review members and as an advocate for the patient and their families.
Attends PCMH team meetings and medical home strategic planning groups to provide updates regarding process improvements.
Participates in designing improved clinical care delivery systems and identifies opportunities and set priorities to continuously improve the referral process and organizational performance through data collection and monitoring activities set by PRC, the medical home care team, and the facility’s strategic planning initiatives.
Promotes the coordination, collaboration, and continuity of care by direct services as an ambulatory case manager. This workload includes both actual case management consults, as well as work on complex referrals (especially for non-resourced patients). These duties include:
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Intake and screening: Screens patients (identified through the triage line, case management consult) that require case management intervention. Receives information from HHC staff, other non-HIS facilities, and from service units concerning contract facility and referral patients.
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Comprehensive Assessment: completes an assessment or coordinates patient assessments with the interdisciplinary care teams. Documents the patient’s condition and situation, including information on demographics, medical/physical status, functional status, mental/emotional/behavioral status, environment, finances, and support system. Synthesizes information and develops recommendations and treatment plans for provision of care and/or services in conjunction with the provider and the patient and family.
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Service planning and implementation: Develops with the patient/family and interdisciplinary team (including IHS and non-HIS providers as appropriate) a care and service delivery plan based on the needs identified and available provider and financial resources. Obtains needed services for patient through arrangements with service providers. Identifies gaps in available community services and resources. Serves as a resource person on issues concerning case management/managed care for providers, patients, & their families and providers.
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Monitoring and coordination: Reviews charts and care plans and contacts patient/family members and service providers as necessary to determine if services are being delivered as planned, and if services are meeting needs.
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Reassessment: Reassess the patient/family to determine if their condition or situation has changed, to evaluate the effectiveness of the care plan to meet goals and to determine if services continue to be cost effective. Revises goals and the plan of services accordingly. Maintains electronic records on the status of the patient, including assessment, service plan intervals, a standard format for program monitoring and evaluation.
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Termination of case management services: Prepares patient, family, and providers for termination (discharge) from case management when services are no longer required. Arranges for any ongoing support/direct care services that the patient will need in coordination with service unit case managers and discharge planners, to include tribal entities when appropriate (ex: tribal social services).
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Manages the outpatient case management central triage line, which consists of consultations from a variety of health care providers (doctors, nurse practitioners, specialty/contract providers, nurse midwives, physical therapy, dietary, pharmacy, social services, and mental health practitioners). Assesses the level of care needed and the effective use of resources.
Performs other duties as assigned.
KNOWLEDGE REQUIRED BY THE POSITION
Professional knowledge of nursing concepts, practices, and procedures to perform specialized nursing assignments (case management, public health, nursing, discharge planning) of an advanced nature and considerable difficulty requiring extended training and experience in various areas of nursing.
Knowledge of institutional, community, and regional health care systems to serve as an authority in matters pertaining to care coordination and case management.
Working knowledge of the operation of national and state health care financing, purchased, and referred care program including coordination of benefits, Medicare and Medicaid program benefits, accessing private insurance benefits, and health care contracts and agreements is essential.
Must possess and maintain a current, valid, active State licensure as a professional registered nurse.
Must possess and maintain a current basic life support certification per HHC policy.
Knowledge of managed care concepts of health care services delivery including utilization review, pre-admission and concurrent review criteria, the use of clinical pathways and practice guidelines and discharge planning.
Knowledge of a broad base of current practice in various health care delivery systems, including inpatient, outpatient, emergency care, and specialty care processes, diagnostic categories, discharge planning, home health, and current treatment regimens and modalities is essential.
Working knowledge of continuum of care resources available in the local, rural, and metropolitan area. General knowledge of resources available to patients in their local communities. Ability to independently access appropriate information through phone contacts and communication. Network with other facilities throughout the state, region, or nation.
Knowledge of medical terminology and anatomy is required.
Knowledge of health care regulations and standards such as The Joint Commission, Centers for Medicare and Medicaid Services Conditions of Participation, AAAHC, and the Medical Home requirements.
Working knowledge of the RCIS, RPMS, EHR, iCare computerized clinical and pertinent administrative information systems. General knowledge of computer programs available to staff at
HHC (Microsoft Outlook, Word, Excel, PowerPoint, ITAS), which allows incumbent to use computer programs and database to present findings, report actions or document interventions.
Working knowledge of the International Classification of Diseased (ICD) and Current Procedure Terminology (CPT-R), length of stay criteria, Diagnosis Related Groups (DRGs), Medicare and Medicaid program benefits.
Skill in working and interacting with a variety of groups of health care professionals. Demonstrated interpersonal skills to interact in a positive way with a wide variety of professional and other staff to elicit support and cooperation in meeting patient care goals.
Skill to work independently to set and prioritize goals to apply learned knowledge and skills of case management.
Skill in coordinating interdisciplinary activities and to communicate effectively and clearly to promote positive group interactions toward meeting overall program and organizational goals.
Skill in establishing and maintaining healthy relationships with patients, families, provider agencies and providers from varied disciplines across city, county, tribal, and federal organizations.
Skill in exercising good judgement in the development and implementation of case management plans. Work requires good composure, a positive attitude, organized, and timely work practices.
Company DescriptionHaak'u Health Center, formally Acoma/Canoncito/Laguna (ACL) Clinic is now hiring! Please consider joining the Haak'u Health Center team.
Company Description
Haak'u Health Center, formally Acoma/Canoncito/Laguna (ACL) Clinic is now hiring! Please consider joining the Haak'u Health Center team.