RN Case Manager

Job Description :

This position functions within the nursing department and is responsible for coordinating the delivery of appropriate and timely care for patients, promoting quality and cost-effective health care outcomes.

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Shift Details

M-F 8-5

Key Essential Functions and Accountabilities of the Job

Responsible for the active management of SEARHC patients.

Collaborates with the medical provider and all interdisciplinary team members to establish individualized medical goals that maximize patient healthcare outcomes.

Coordinates multi-disciplinary care conferences for high risk or complex patients who are referred into the case management process.

Manages panel acute and chronic care needs as well as health maintenance, by continuously reviewing EHR reminders and triggers and providing outreach and education to patients.

Participates in case management reviews where all high need patients are reviewed with a multi-disciplinary team of providers.

Works with multi-disciplinary team as an advocate for the patient / client family at the service -delivery level, fostering patient / family decision making, independence, self-care and growth and development.

Uses problem-solving and anticipatory skills in meeting the needs of the patient and the provider. Patient needs should be addressed in a prompt, efficient manner.

Facilitates the coordination of patient referrals within SEARHC other outside facilities. Tracks the progress of referrals and outcomes of care, providing periodic status report to providers on outstanding referrals. Serves as the primary link for other case managers and discharge coordinators in care coordination for the patients. Ensures referral records have been received and are available for provider's review. Proactively identifies delays and obstacles to care and works to remedy individual cases and to improve the process.

Performs staff nursing duties in the various nursing roles in the clinic. Duties include assessment, documentation, education and administering appropriate medications and / or therapies.

Maintains annual competencies including safety and infection control requirements. Performs duties as assigned in a responsible, respectful, and caring manner to promote effective nursing staff relationships. Maintains a clean and safe working environment including adequate supplies and upkeep of unit and equipment, reporting any defective or missing equipment and safety hazards. Adheres to infection control policy and procedures.

Communications and Teamwork

Works collaboratively by building bridges and creating rapport with team members within departments and across the organization.

Participates in department and clinic team and improvement efforts.

Active member of the clinical team and is a leader amongst the pod, nursing staff and unit coordinators.

Participates in continued development of the case management role in primary care.

As an RN is responsible for participating in the triage role and responding to emergency situations.

Performs other duties as assigned, including special projects deemed necessary to provide comprehensive health services.

Additional Focus Areas

Specialty Clinic - Facilitates the coordination of specialty clinic referrals. Manages referrals and waitlists. Reviews referrals for appropriateness and completion of work-up labs and / or diagnostics. Consults with referring providers for questions or concerns. Schedules patients in requested clinic based on priority system. Ensures pre-appointment diagnostics are ordered, scheduled, and completed. In consult with other facilities, coordinates various clinics including dates and times for clinic availability. Tracks the progress of referrals and outcomes of care, providing periodic status report to providers on outstanding referrals. Ensures referral records have been received and are available for provider's review.

Primary nurse for all specialty clinics, providing clinical support. Including assessment, documentation, education and administering appropriate medications and therapies. Prepares clinical space for selected clinic (i.e., appropriate medical equipment). Sets up and assists the provider during various medical procedures (i.e., colposcopy, cystoscopy). Assists the medical staff with educational in-services provide by the specialty clinic providers.

OB Case Management - Primary case manager OB patients. Is responsible for the intake and tracking processes. Is responsible for education and outreach for OB patients. Works closely with the primary care providers and case managers to ensure comprehensive care for patients. Tracks postpartum care and newborn immunizations.

VTC - Communicates and coordinates all video teleconferencing visits with Specialty providers from AK Native Medical Center. Acts as nursing staff for those visits.

ETT - Manages referrals and coordinates appointment times with Bartlett, SEARHC provider, and patient for Exercise Treadmill tests (Juneau).

Education, Certifications, and Licenses Required

Graduate of an accredited school of nursing Bachelor's degree preferred.

Current full, unrestricted Registered Nursing license in Alaska or other U.S. state required.

Direct Hire must have applied for an Alaska nursing license before start date.

Agency staff must have an active Alaska license.

Basic Life Support certification.

National Case Management certification preferred.

High school diploma or equivalent required.

Clinical Competency required within 3 months of hire and every three years

Experience Required

At least 1 year of general nursing experience with at least 6 months' employment as a clinical nurse at a SEARHC outpatient clinic OR at least 2 years of general nursing experience with a minimum of 1 year in an ambulatory setting or 1 year case management experience.

Knowledge of

SEARHC services and those of other tribal health organizations in Alaska

The nursing process and the ability to apply this knowledge in the working environment.

Customer service principles.

Safety and infection control principles.

Skills in

Assessment, anticipation of needs, and data collection.

The use of equipment such as computers and medical equipment.

Oral and written communications.

Ability to

Multi-task and work independently in fast paced environment.

Maintain compliance with annual competencies.

Problem-solve and use conflict resolution skills to develop and maintain good working relations with other staff and departments.

Anticipate needs of others and to seek help when appropriate.

Ability to work within a very fast paced clinical setting.

Move at a quick pace, stand for long periods of time, bend, stoop, climb and move to the floor.

Follow simple and complex directions and perform multiple tasks at once.

Perform job using theory-based nursing practice model, evidence-based practices, and shared governance in a multi-disciplinary setting.

Physical Demands :

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; sit; use hands to finger, handle or feel and reach with hands and arms.

The employee is occasionally required to climb or balance; stoop, kneel, crouch or crawl. The employee must lift and / or move 50 lbs.

Required Certifications :

Basic Life Support (BLS) - American Heart Association, Clinical Competency Assessment - SEARHC, Registered Nurse License - State of Alaska - Alaska State Board of Nursing

Position Urgency : Normal

Shifts : Days, Full Time

State License Details :

Upon Acceptance

Minimum Years of Experience :

Specialty Type :

Nursing

Sub Specialty : Care Manager

Bilingual : No

Holiday Coverage Required :

No