Registered Nurse - Case Manager

Job Overview

We have a new opening for a Registered Nurse - Case Manager at Tinker Air Force Base, Oklahoma

Provides case management, care coordination and discharge/disposition planning for inpatient and outpatient care settings. Assists service members and/or veterans, family members and caregivers with receiving the most appropriate options and services to meet their complex health care needs. This includes, but is not limited to, acute, chronic, multiple, complex, catastrophic, or life-threatening illnesses; combat stress, residuals of traumatic brain injury; community adjustment;

addictions, Transgender Care, and other health problems. Coordinates care with multiple providers across all levels and sites of care. Addresses psychosocial, as well as nursing and medical needs of patients and their families/caregivers, through participation in multidisciplinary patient care management practice. Evaluates care and outcomes to ensure timely and appropriate provision of services.

Serves as the Transgender Care Liaison (TCGL) for Tinker AFB population and coordinates all transgender care in coordination with the Transgender Health Medical Evaluation Unit (THMEU) in San Antonio, Tx. The Case Manager will be required to attend a 1 (one) week TDY, furnished by the 72 MDG, at THMEU to obtain required trainings to serve as the TCGL.

• Assessment:
  Identification of patients for case management; comprehensive collection of patient information and medical status; and continued evaluation of an established plan of care;
• Planning:
  Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan of care;
• Facilitation:
  Care coordination and communication among all involved parties;
• Advocacy:
  Support for the patient and family/caregivers to ensure identified education and appropriate, timely care is received.

• Must be knowledgeable in medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]); accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC); and computer applications/software to include Microsoft Office programs, MS Outlook (e-mail), and internet familiarity is required.
• Must be skillful and tactful in communicating with people who may be physically or mentally ill, uncooperative, fearful, emotionally distraught, and occasionally dangerous.
• Must possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/caregivers, medical and non-medical staff in a professional and courteous way.

• Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management (CM) standards of care.

• Provide nursing expertise about the CM process, including assessment, planning, implementation, coordination, and monitoring. Identify opportunities for CM and identify and integrate local CM processes.

• Develop and implement local strategies using inpatient, outpatient, onsite and telephonic CM

• Develop and implement tools to support case management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.

• Integrate CM and utilization management (UM) and integrating nursing case management with social work case management.

• Maintain liaison with appropriate community agencies and organizations.

• Accurately collect and document patient care data.

• Develop treatment plans including preventive, therapeutic, rehabilitative, psychosocial, and clinical interventions to ensure continuity of care toward the goal of optimal wellness.

• Establish mechanisms to ensure proper implementation of patient treatment plan and follow-up post discharge in ambulatory and community health care settings.

• Provide appropriate health care instruction to patient and/or caregivers based on identified learning needs.

Monday - Friday 8 hour shift between 7:00am to 4:00pm

No Weekends!

No Holidays!