RN Case Manager

Ouzinkie Native Corporation; Colorado Springs (CO); On-site; USD 65,000 - 90,000; Full time

Job summary

Ouzinkie Native Corporation is seeking a BSN-credentialed Case Manager to coordinate healthcare services for TRICARE/Medicare beneficiaries. The role requires collaborative work with military and civilian providers and use of UM systems to manage high-risk patients.

Responsibilities include eligibility determinations, care coordination, multidisciplinary treatment planning, and comprehensive recordkeeping. A current US nursing license and BLS are required.

Qualifications

• BSN from a NLN or AACN accredited college or university as delineated by Headquarters United States Air Force Surgeon General.
• At least three years of medical or surgical experience and at least one year in Case Management.
• Active, unrestricted US nursing license (including NLC/eNLC) or a license from any US jurisdiction; current and in good standing.
• Current state nursing license in good standing.
• Extensive knowledge of TRICARE, Medicare/Medicaid benefits.
• Experience with pediatric, adult and geriatric case management assessment.
• Proficiency with basic office automation and information management tools.
• Current BLS healthcare provider certification.
• Credentialing and site health screening requirements must be maintained.
• Ability to obtain required security access/background checks.

Responsibilities

• Coordinate healthcare coordination and case management services for TRICARE/Medicare beneficiaries within MTF.
• Collaborate with military and civilian healthcare providers; use UM system support to identify high-risk/high-cost patients.
• Determine eligibility for coordination/case management services.
• Coordinate with providers to ensure appropriate appointment alternatives, access and quality of care.
• Develop multidisciplinary treatment plans addressing identified conditions and needs.
• Maintain patient records and report monthly care summaries to MM or designee.
• Attend discharge planning conferences and contribute to education and competency of staff.

Skills

Oral communication

Written communication

English proficiency

Interpersonal skills

Team collaboration

Time management

Education

BSN from NLN/AACN accredited program

Tools

Utilization Management systems

Office automation (word processing, databases, email)

Job description

SUMMARY:

Performs healthcare coordination and case management activities IAW Medical Treatment Facility (MTF) instructions.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Ensures compliance with standards of care and practice (Accreditation Association for Joint Commission on Accreditation of Healthcare Organizations(JCAHO), Ambulatory Health Care (AAAHC) & Case Management Society of America (CMSA)).
• Collaborates with military and civilian healthcare providers and staff and uses Utilization Management (UM) systems support to identify high-risk/high-cost patients within MTF population.
• Determines eligibility for healthcare coordination/case management services.
• Coordinates with healthcare providers to ensure appropriate appointment alternatives, access and quality of care.
• Coordinates services for eligible patients based on subjective and objective assessment data and identified patient/family needs.
• Facilitates a multidisciplinary team to develop a treatment plan to address all identified conditions and problems. Integrates health education, promotion and prevention activities utilizing available MTF and local civilian condition/disease management resources. Participates in the orientation, training, and evaluation of competency of newly assigned Case Management personnel.
• Attends bi-weekly and as-needed multi-disciplinary discharge planning conferences within the MTF and as needed at the local treatment facilities.
• Assists TRICARE eligible and Medicare-eligible patients in accessing local TRICARE and Medicare providers in conjunction with the MTF Referral Centers and the Central Referral Center.
• Maintains current directories of local Medicare providers, suppliers, and Institutions.
• Evaluates case management process utilizing defined parameters such as admissions, length of stay, level of care, Emergency Department/outpatient clinic visits and patient outcomes and institutes appropriate interventions.
• Generates and maintains appropriate patient administrative records and provides upon request.
• Reports monthly summary of care to Director, Medical Management (MM) or designee.
• Conducts monthly evaluation, in conjunction with Primary Care Management (PCM) team, the benefit of case management. Closes case management cases when maximum patient benefit has been obtained.
• Ensures a safe work environment and employee safe work habits.
• Maintains regular and punctual attendance.
• Performs all other duties as assigned.

SUPERVISORY RESPONSIBILITIES:

None.

MINIMUM QUALIFICATIONS:

• Bachelor of Science Degree in Nursing (BSN) from a National League of Nursing (NLN) or American Academy College of Nursing (AACN) accredited college or university as delineated by Headquarters United States Air Force Surgeon General.
• Minimum of three (3) years of documented medical or surgical experience and at least one (1) year experience in Case Management.
• Possess a current, active, full, and unrestricted license in any US United States or jurisdiction, be able to practice using a nurse compact state license or Enhanced Nurse Licensure Compact (eNLC) or have a license from any United States jurisdiction.
• Must maintain a current, valid, and unrestricted State nursing/social worker license in good standing.
• Extensive knowledge of TRICARE, Medicare/Medicaid services and benefits is mandatory.
• Knowledge of professional care theories, principles, practices, and procedures to perform patient assessments with specific experience in the case management evaluation and assessment of pediatric, adult, and geriatric patients as appropriate.
• Demonstrates knowledge, skill, and ability to use basic office automation and information management equipment and programs (i.e., word processing, database management, email, etc.).
• Life Support Certifications: Must possess and maintain current Healthcare Provider Basic Life Support (BLS). This Certification must be current at all times, at no additional expense to the government.
• Must obtain and maintain all required documents, certifications, licenses, etc. listed on the credentialling checklist, sent by Katmai's Credentialing Specialist, for this position for initial hire. All certifications listed must be maintained. Expired certifications are not valid.
• Must obtain and maintain the site's required health screening and immunization requirements.
• Must obtain and maintain any necessary security access and/or background checks.
• Must obtain and maintain all required documents, certifications, licenses, etc. listed on the credentialling checklist, sent by Katmai's Credentialing Specialist, for this position for initial hire.

DESIRED QUALIFICATIONS & SKILLS:

• Case Management certification desired.
• Working knowledge of the military health care system as well as local community resources strongly preferred.
• Experience in outpatient, home-health care, skilled nursing facility, hospice and mental health services are desired.
• Experience with Medicare Eligible patients preferred.
• Excellent patient assessment skills.
• Excellent oral communication skills for patient education and telephone management of patients.
• Sufficient initiative, interpersonal relationship skills and social sensitivity such that they can relate constructively to a variety of patients and healthcare staff from diverse backgrounds.
• Ability to effectively read, write and speak English in order to communicate with all patients and other healthcare providers.
• Ability to effectively communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization.
• Excellent written communication skills to perform accurate documentation, both written and electronic, of all activity in accordance with requirements.
• Demonstrates ability to prioritize, organize, problem-solve, and coordinate daily activities to support effective improvement in individual patients.

WORK SCHEDULE:

Full-time. May be required to work additional hours as needed to complete assignment or project.

TRAVEL:

All Market contractors are subject to working at a duty location at any of the MTFs or associated sub clinics within the Colorado Military Health System (CMHS).

DRIVING REQUIREMENTS:

None.

WORK ENVIRONMENT:

Work is performed primarily indoors at a well-lit military treatment facility such as a clinic, outpatient facility or hospital. The environment is normally air conditioned, but conditions may change dependent upon circumstances. Work may need to be performed in a fast-paced environment requiring quick thinking and rapid judgements. Employee will be exposed to a wide variety of clients in differing functions, personalities, and abilities. Exposure to bloodborne pathogens and bodily fluids, latex, radiation or other contaminants and safety issues. May be exposed to infection or diseases from contact with patients.

PHYSICAL DEMANDS:

Position consists of sitting for long periods of time, using hands/fingers, handling, reaching with hands and arms, speaking, or translating. Periods of walking, standing, bending, kneeling, stooping, crouching, and lifting boxes weighing up to 30 pounds. Moderate to extended periods of office work with heavy periods of computer usage. It is Katmai's business philosophy and practice to provide reasonable accommodations, according to applicable state and federal laws, to all qualified individuals with physical or mental disabilities.

COMPLIANCE:

We are a VEVRAA Federal Contractor. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, race, color,religion, sex, sexual orientation, gender identity or national origin, disability status, protected veteran status, marital status, familial status or any other characteristic protected by law.

Preference will be given to Ouzinkie Shareholders, Descendants of Shareholders and Spouses of Shareholders in accordance with Title 43 U.S. Code 1626(g) and Title 42 U.S. Code 2000e - 2(i).