Nurse Case Manager

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.
Overview

POSITION SUMMARY

Incumbent serves as an Outpatient/Inpatient Nurse Case Manager for TCRHCC and at Sacred Peaks Healthcare Center (SPHC) as the supportive contact for specified groups of identified high risk patients; will specifically focus on specialty clinics that need specific Case Management attention. The case manager meets essential health and social needs for patients while ensuring quality, cost effective healthcare. The case manager facilitates care transitions from admission through discharge ensuring continuity of care, alignment of services, and post hospital referrals to continuing care agencies. Also serves as a resource for nursing, physicians and ancillary departments on transitional and regulatory issues. The case manager will experience working with culturally diverse patient populations having multiple barriers to self-sufficiency such as: illiteracy, welfare dependency, domestic violence, substance abuse, and mental health issues. The Nurse Case Manager will be responsible for assessment, service planning, resource acquisition, monitoring progress and initiating the responding to emerging client needs.

Collaborates with an interdisciplinary team to assess care plans, monitor progress, and make recommendations to ensure safe and efficient hospitalizations. Responsible for evaluating patients in the ED for medical necessity and care coordination needs. Assesses potential admissions and works with advanced practice clinicians/physicians to determine appropriate admission status. Proposes and implements outpatient plans for safe discharge from the ED with physician approval. Coordinates care for patients with abuse, chronic pain, and frequent utilization issues. Interacts with patients or customers of all ages, from newborn to geriatric.

As part of this role, they will also interact with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being. with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being.

Qualifications

NECESSARY QUALIFICATIONS

Education:

Associate’s or Bachelor’s Degree in Nursing

Certifications/License:

• A valid, current, full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States
• Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association throughout employment

Experience:

• Three (3) years of clinical nursing experience with (1) year in an Outpatient/Inpatient setting
• Demonstrated knowledge of the case management, contract health, and utilization review processes

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

• Positive working relationships with others
• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences
• Effective verbal & written communication skills
• Team management focus promoting a positive and pro-active approach to problem resolution
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

MENTAL AND PHYSICAL EFFORT

The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical:

Work requires walking, periods of standing, and sitting. Work also requires extensive periods of time working at a personal computer. Must be able to lift up to 25 lbs (i.e. medical charts); must be able to distinguish numbers, letters, and colors.

Mental:

Contacts often require tact and sensitivity as those related to stressful situations such as death, dying and catastrophic illnesses. Must be able to prioritize, use good judgment, and coordinate a variety of issues while being frequently interrupted.

Responsibilities

ESSENTIAL FUNCTIONS

1. Provides comprehensive and client centered service planning and coordination for a specified group of high-risk patients.
2. Manages care of prioritized TCRHCC/SPHC outpatient/inpatient based upon consultation from providers within the TCRHCC/SPHC healthcare delivery system; provides a consistent and on-going consultation with service providers.
3. Works collaboratively with providers and other disciplines to develop and maintain high risk patient database to ensure the continuity of care is established and maintained for the TCRHCC/SPHC outpatient/inpatient population.
4. Works proactively and collaboratively with Utilization Review (UR), Public Health Nursing (PHN), Patient Benefit Coordinators (PBC), and Purchased Referred Care (PRC) at TCRHCC/SPHC.
5. Facilitate communication and coordination between members of the health care team, involving the client in the decision-making process in order to minimize fragmentation in the services (CMSA, 2010).
6. Independently develops and maintains resource databases to ensure timely and accurate information for patient referrals and minimize fragmentation in patient care services.
7. Develops with the patient/family and multidisciplinary team (including service area and/or other non-TCRHCC/SPHC providers as appropriate) a care and service delivery plan based upon the needs identified and available provider and financial resources of the patient and provides consistent and on-going case consultation with all direct service providers.
8. Provides service monitors and follow-up to ensure continuity of care, and updates of the client service plan and provides follow up if needed. Striving to promote client self-advocacy and self-determination (CMSA, 2010).
9. Prepares patient and family 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 post-discharge in coordination with discharge planners and other entities such as PHN, Community Health Representatives or Tribal Social Services.
10. Develops reports, performance improvement projects, establishes policy and procedures and program objectives.
11. Will provide Case Management coverage for the Adult Care Unit, Pediatric Unit, Intensive Care Unit, Obstetrics Unit, Emergency Room and Outpatient Departments.
12. Will be familiar with Advance Directives and be a resource person for patients and families; facilitate informed choice, consent, and decision-making.
13. Promote use of evidence-based care, as available, in conjunction with the MCG Care Guidelines.
14. Pursue professional excellence and maintain competence in practice.
15. Serves as the outpatient/inpatient coordinator, such as:
16. The primary contact for outpatient/inpatient in obtaining beds for admissions both within and outside of TCRHCC/SPHC.
17. Collaborate with provider and nursing personnel to ensure admissions are conducted seamlessly and without delay of patient care.
18. Collaborates with provider, nursing personnel and patient benefits coordinators that all admission documentation is complete and all referrals for third party resources are complete prior to the departure of patients.
19. Required to take call on scheduled weekends as deemed necessary.
20. Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.
21. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
22. Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction.
23. Performs Other Duties as Assigned.