POSITION SUMMARY
The Registered Nurse Case Manager (RNCM) will coordinate care and communication for members with moderate to severe complexity of care between and within health care service agencies in partnership with members, families and caregivers. The RNCM also provides nurse triage telephonically.

The Native American Health Center is an accredited institution and adheres to the standards of excellence set forth by the Accreditation Association of Ambulatory Health Care (AAAHC) and the Commission of Dental Accreditation (CODA).

DUTIES AND RESPONSIBILITIES
Case Management Duties and Responsibilities
1. Collaborate with interdisciplinary team and utilize clinical tools to develop and manage the overall long-term health care plan for members with chronic or serious conditions.
2. Coordinate specialty appointments and monitor follow-up to ensure appointments are kept and care is delivered in alignment with the care plan.
3. Act as a member advocate and educator ensuring that members and families are educated and empowered to participate in the plan of care and to navigate complex medical decisions.
4. Serve as a clinical liaison between members and their insurance providers, which includes managing prior authorizations (PA), ensuring members have required medications and expediting PA’s for special procedures.
5. Promote the efficient and effective utilization of clinical resources (i.e. ordering required tests and monitoring symptoms and signs that indicate member’s response to treatment.)
6. Facilitate a relationship between the family and the member to enable them to make informed decisions.
7. Assist and facilitate members in obtaining medical services through scheduling appointments, triaging members and assessing members who are seeking services.
8. Provide health education, and counseling members on preventative health and chronic conditions.
9. Facilitate transitions of care for members, including planning, coordinating with all involved parties and documenting in the member’s record. Review hospital discharge summaries and Emergency Department visit notes and notify primary care providers of important medical and social issues during hospitalization
10. Oversee tracking and follow-up procedures for referrals, consultations, diagnostic studies and missed appointments for members.
11. Support the Care Team by processing medication refills, delivering test results, calling members, and other nursing services as needed.
12. Conduct medication reconciliation telephonically to the best of the RN’s ability while also assessing healthcare literacy and adjusting nursing interventions & education to meet the needs of the member.
13. Manage mammograms, biopsies, breast ultrasounds under the guidance of providers.
14. In coordination with providers, oversee the abnormal pap smear process. This will include tracking, scheduling appointments, and recalling members, etc.
General Duties and Responsibilities
15. Perform clinical nursing duties and responsibilities with high integrity and quality.
16. Identify and respond appropriately to the health care needs of all members.
17. Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices.
18. Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
19. Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
20. Quality Improvement: Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned.
21. HIPAA: Keep all protected health information (PHI) confidential and abide by HIPAA policies for the release and disclosure of any PHI. Will report unauthorized use of disclosure of PHI immediately, to supervisor or HIPAA security officer.
22. Work well under pressure, meet multiple and often competing deadlines.
23. At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
24. Other duties as assigned by supervisor, Medical Executives or their delegate.