JOB Under general supervision from the Nurse Administrator in the Salt River Clinic, is responsible for the day-to-day operations of the River People Health Center Case Management Department, including Community Health. The role includes ensuring that RN Case Managers and the Community Health Team coordinate care to optimize patient outcomes, enhance the patient experience, and increase the delivery of recommended preventative and chronic care management for the patients served by the Community. This position will be responsible for the adherence to the budget and monitoring productivity to support various departmental needs, scheduling staff and record keeping.
This job class is treated as FLSA Exempt.
Essential Functions: Essential functions may vary among positions and may include the following tasks, knowledge, skills, abilities and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be a comprehensive listing of tasks performed by all positions in this classification
EXAMPLE OF DUTIES
1. Management/ Leadership: The Manager of RPMC Case Management is responsible for management and oversight of the Care Management Programs including Transitional/ Ambulatory/ Chronic subset of Case Management population and the Community Health Program.
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Directly responsible for daily operations of the Program and Department and for operational partnership with Benefits Coordination and Purchased Referred care.
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Oversees Lead interdisciplinary care conferences between transition and complex case managers and conduct regular case reviews with care management staff of complex and/or high acuity cases.
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Oversees Clinical Case Management Liaison engagement with partnered clinical facilities and providers to optimize the management of patient with complex care needs.
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Oversees Utilization Review RN CM and Referral Coordination Team.
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Provide oversight and supervision in the planning, development, implementation, and evaluation of quality improvement initiatives within the Case Management Department.
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Ensure staff are fully trained and adherent to established documentation standards.
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Prepares shift schedules and coordinates time off, process weekly time.
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Resolving conflicts among staff and between staff and RPHC personnel.
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Overseeing daily operations of the department and ensuring optimal use of everyone’s time and skills.
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Develops staff goals and objectives for evaluation, evaluates performance of assigned department staff and conducts timely performance evaluations (EPAR’s).
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Observes policies, procedures and guidelines with respect to the HHS and RPHC’s protocols.
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Ensures staff are qualified and trained with tools to support successful execution of their duties,
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Assigns and directs the daily workflows and associated clinic area activities
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Understands and operationalizes the IHS Community Health Program.
2. Workflow, supervision and management: Oversees Salt River case management and community health nursing staff.
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Provides full technical and administrative supervision of nursing staff.
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Prepares shift schedules, and coordinates time off for nursing staff.
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Monitors attendance and timecards.
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Maintains nursing operations by initiating, coordinating, and enforcing program, operational and personnel policies and procedures.
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Outlines goals and objectives for evaluation, evaluates performance of clinic nursing staff and conducts timely performance evaluations.
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Provides training and leadership for the clinic nurses to accomplish the community’s health goals and standards of care for the clinic including care/treatment plan documentation, licensure requirements, etc.
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Ensures safe and clean working environment by coordinating with nursing staff following procedures and when necessary.
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Manages core staffing plan and employs flexible staffing plan as necessary.
3. Case Management Departmental Management: Maintains direction with community objectives on standards of care and operations. Oversees and coordinates care of patients designated as low, rising or high risk for progression of disease, or those with clinical decline or in need or emergent care.
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Works in collaboration with other Medical Management Departments to ensure optimal clinical outcomes, appropriate resource utilization, quality patient care, and high patient satisfaction.
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Ensure all patient interactions will be conducted in accordance to HIPPA regulations to maintain patient confidence and protect confidential information.
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Ensures that RN Case Managers and the Community Health Team work in collaboration with the primary and/or specialty physicians, healthcare team and the patient to provide coordination of care to those patients with complex and/or high risk conditions.
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Ensures the Case Management Departmental staff and Community Health Team verify identification of patients, provides screening, assessment, planning, implementation, coordination, monitoring and evaluation of health care services provided to the high risk population.
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Collaborate with other organizational departments responsible for functional aspects including, but not limited to Community Health Resources, Behavioral Health, Benefits Management, Quality Management, , Information Systems, Finance, Claims
4. Program Operations/ Protocols: Develops and maintains processes to oversee ambulatory case management including standardized documentation and auditing, program that maximize quality, programs to ensure appropriate resource utilization within patient benefit plan and established contracts.
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Contribute to the development and maintenance of an effective evaluation and monitoring system and utilize a variety of reports for staff coaching and program improvement.
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Participate in committees, as assigned.
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Ensures the goal of the program is optimizing patient outcomes, enhancing the patient experience, avoiding preventable inpatient admissions/readmissions, avoiding preventable/non-emergent emergency department visits, and increasing the delivery of recommended preventative services.
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Participate in the writing and interpreting HHS & RPHC policies and procedures
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Follows all departmental and Community policies and procedures
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Maintains department direction with River People Health Center objectives on standards of operations including monitoring productivity and revenue projections.
5. Patient Interaction: If needed, assist with clinic nursing duties, including obtaining health histories and performing physical assessments.
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Initiates preventative health measures within the scope of practice for a professional Registered Nurse (RN).
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Evaluates and carries out medical providers' orders.
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Initiates appropriate interventions according to health care priorities identified in assessments.
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Adheres to established policies and procedures and standing orders.
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Coordinates programs, services and other activities to implement targeted health promotion and disease prevention activities.
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Maintains patient confidence and protects operations by monitoring confidential information processing.
6. Patient Documentation, Care & Treatment Plans: Documents patient charts which includes subjective and objective data, treatment provided, evaluation of treatment effectiveness and patient education.
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Develops and documents nursing care plans and interdisciplinary treatment plans.
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Establishes and maintains documentation and communication flow at each program site.
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Appraises quality and effectiveness of documentation and education materials and equipment as needed.
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Recommends changes when necessary and follows through to ensure that agreed upon changes are implemented and maintained.
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Participates in administrative on-call schedule (if needed) and coordinates case management on-call schedule if such a call schedule is required.
7. Networks with insurance companies, self-insured employers, case management firms and/or other health care networks.
8. Updates professional knowledge and proficiency in nursing through continuing education, staff meetings, training and conferences, etc.
9. Performs other job-related duties as assigned to maintain and enhance departmental operation.
Knowledge, Skills, Abilities, and Other Characteristics:
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Knowledge of the history, customs, culture, traditions and government of the Salt River Pima- Maricopa Indian Community.
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Knowledge of medical, public health and social service resources available to Community members including, but not limited to, Indian Health Service (HIS), Medicare, Medicaid, ALTCS, SSI, etc.
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Knowledge of assessment, diagnostic, preventative and therapeutic procedures used in a community health program.
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Knowledge of federal, state and SRPMIC laws and regulations governing professional nursing practices.
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Knowledge of theory, principles and scope of practice for a professional Registered Nurse.
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Knowledge of theory and practices of management in nursing services.
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Knowledge of counseling theory and techniques as well as learning principles and strategies.
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Knowledge of health systems and disease processes.
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Knowledge of data collection and analysis.
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Knowledge of public health practices and concerns.
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Skill observing, assessing and documenting the behavior and progress of patients.
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Skill assessing client needs and developing care plans.
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Skill applying professional Nursing methods and techniques as well as emergency medical procedures including First Aid and Basic Cardiac Life Support.
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Skill with verbal and written communication and the ability to communicate effectively with a wide range of people, clients, families, community groups and health professionals.
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Skill managing various employee types in stressful situations
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Skill with program planning, operational processes, and creating department budgets.
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Ability to establish and maintain positive and effective working relationships with colleagues, subordinates, supervisors, health care professionals, Tribal officials, representatives or resource agencies, patients and Community members.
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Ability to work as a productive member of a team.
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Ability to deal with sensitive issues and maintain appropriate, professional and confidential relationships.
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Ability to incorporate cultural differences, health beliefs and learning styles.
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Ability to develop and implement program protocols as well as identify and address programmatic problems.
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Ability to use a personal computer and related software, including MS Office along with a variety of standard office equipment including cellular phones, photocopiers, FAX machines and calculators.
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Ability to bend, lift, and move in a manner consistent with the duties assigned.
SUPPLEMENTAL INFORMATION
- May be required to work beyond normal work hours including nights, weekends and holidays.
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Employees in, and applicants applying for, jobs providing direct services to children are subject to the “Community Code of Ordinances”, Chapter 11, “Minors”, Article X. “Investigation of Persons Working with Children”.
Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check. Employees are subject to random drug and alcohol testing.
"SRPMIC is an Equal Opportunity/Affirmative Action Employer" Preference will be given to a qualified: Community Member Veteran, Community Member, Spouse of Community Member, qualified Native American, and then other qualified candidate.
In order to obtain preference, the following is required: 1) Qualified Community Member Veteran (DD-214) will be required at the time of application submission 2) Qualified Community Member (must provide Tribal I.D at time of application submission),3) Spouse of a Community Member (Marriage License/certificate and spouse Tribal ID or CIB is required at time of application submission), and 4) Native American (Tribal ID or CIB required at time of application submission).
Documents may be submitted by one of the following methods:
1) attach to application
2) fax (480) 362-5860
3) mail or hand deliver to Human Resources.
Documentation must be received by position closing date.
IHS/BIA Form-4432 is not accepted.
Your Tribal ID/CIB must be submitted to HR-Recruitment-Two Waters.
