Clinical Case Manager - RSIC



RENO-SPARKS INDIAN COLONYPosition Title:Clinical Case ManagerDepartment:Health and Human ServicesSupervisor:Medical Director / Ancillary Nurse ManagerStatus:Regular, Full-Time; Monday – Friday – 8:00 a.m. – 5:00 p.m.FLSA:ExemptApproved by:____________________________________________ Date: _____________ Approved by:____________________________________________Date: _____________Employee Name/Print: _____________________________________ Employee Signature: _______________________________________Date: _____________Position Summary: The Clinical Case Manager is responsible for assessments; team planning; coordination of individual and family care planning; utilization review; discharge planning, case management and crisis intervention. The overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity of care. This position is accountable to the Medical Director and in her/his absence to the Ancillary Nurse Manager.Duties and Responsibilities:Introduce self to patient and family and explains clinical case manager role and process for patient and family to contact clinical case manager.Ensures continuity of care and cost effectiveness through the integrating and functions of case management, utilization review, care management and discharge and home planning processes with all health center divisions/programs, external service organizations, agencies and healthcare facilities.Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions.Assesses patient care required throughout continuum of care for diagnosis, and procedures. Reviews and interprets findings to distinguish between normal and abnormal condition during patient screening-triage.Collaborate with clinical staff in the development and execution of the plan of care, and achievement of goals.Coordinates and participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling special cases or patient needs.Coordinates the provision of biopsychosocial services to patients, families, and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services. Refers cases where patients and/or family would benefit from treatment required to complete complex discharge plan to appropriate service(s) internally and/or externally.Assists with discharge planning or management of medical care by insurers or managed care organizations.Provides interventions to assist patients obtain entitlement or link to needed services.Ensure that patient tests are appropriate and necessary and are carried out within the established timeframe and that results are promptly available.Assess patient’s progress through expected course of care plan at the Health Center.Promote effective and efficient utilization of clinical resources.Ensure that referrals are done timely by resources and interviews, as needed, to achieve expected goals to assist in clinical outcomes within the desired municates with physicians and appropriate providers at regular intervals throughout Health Center regarding utilization and develops an effective working relationship. Facilitates interdisciplinary patient care rounds and/or multidisciplinary team meetings to review treatment goals, optimize resource utilization, and provide patient and family education. Assist physicians and providers to maintain appropriate cost, case, and desired patient outcomes.Acts as patient advocate for those that are applying for alternative resources such as Patient Assistance Program. Interview patients and family members and consults with attending physicians, and other staff members to determine and evaluate the kind of health and physical care required. Provides ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs.Assist the patient by seeking prior authorization for Medical, Dental or Optometry procedures. Advise the Health & Human Services Director and the Medical Director of any problems related to the implementation and coordination of Clinical Case Management activities and continuity of care.Other duties as assigned.Minimum Qualifications:Bachelors degree from an accredited college or university in clinical social work/or nursing.Minimum of two (2) years of utilization review/case management experience or social work experience. (HAWCC)Minimum of one (1) year experience in discharge planning in Health Care is preferred. Maintain current professional licensure in professional field clinical social work/or nursing.Appropriate certification in case management preferred (e.g., Commission for Case management Certification (CCMC). Able to work effectively with individuals and/or families to assist them in satisfactory solution(s) to health relationships with others.Ability to analyze situations accurately and take effective action.Confirmed ability to effectively communicate both verbally, and in writing to various individuals, cultures and groups. Valid Nevada driver’s license and reliable transportation.Ability to meet the physical demands of walking, standing, some lifting during the performance of normal duties.Annual TB TestKnowledge and application of Public Law 101Ability to work with diverse minority groupsIndian Preference applies.PLEASE NOTE: hiring preference will be given to qualified members of the Reno-Sparks Indian Colony followed by members of other federally recognized tribes. Reno-Sparks Indian Colony requires a designated candidate to successfully complete a pre employment criminal background check, drug screen and confirmation of references. Must pass and comply with the HR Policy 164.905- PL101.630. ................
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