Manager- Medical Case Management

Description

POSITION TITLE: Manager
- Medical Case Management

CLASSIFICATION:
Exempt

DEPARTMENT: Tribal Health

SUPERVISOR: Director of Nursing or Designee

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

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.

Routine duties shall include providing health care related services to individuals eligible for services provided by Washoe Tribal Health Center.

• 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, admission, 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…