RN, Case Manager at Tribal Health, LLC in Santa Fe, New Mexico

Job Description:

RN Case Manager

Santa Fe Indian Health Center

Santa Fe, NM

Position Summary

RN Case Managers are responsible for coordinating patient care services. As the RN Case Manager, you will help determine the type of care needed and the steps that must be taken to ensure the patient receives the care. Responsibilities may include scheduling appointments, determining insurance eligibility and performing exams and evaluations. The RN Case Manager will act in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan and effectively communicate the plan across the continuum of care.

Job Responsibilities

• Use clinical tools, data and other information to complete assessments of patient needs
• Create individualized and comprehensive case management and treatment plans
• Determine insurance eligibility for various treatments and treatment programs
• Clearly explain the reason for prescribed treatments and treatment plans to patients
• Educate patients on benefits, services and other resources, including payment options
• Communicate with patients, physicians and insurance companies to secure successful outcomes
• Document complex medical information to outline and improve health results
• Follow case and quality management processes in compliance with regulatory guidelines and company procedures
• Coordinating complex durable medical equipment orders
• Managing un-resourced and some resourced patient referrals
• Assisting with referral processes and communication
• Participating in care team meetings and strategic planning
• Reviewing patient eligibility and alternate resources
• Maintaining electronic health records
• Educating patients on care plans and health care options
• Assisting with CHEF (Catastrophic Health Emergency Fund) cases

Qualifications

• Bachelor’s degree in nursing required
• Active nursing license
• Clinical knowledge of chronic conditions, such as diabetes and congestive heart failure
• Strong written and verbal communication skills
• Demonstrated ability to assess and respond to patient and family needs in a timely manner
• General knowledge of case management practices, including familiarity with relevant products and services
• Basic computer skills, including working knowledge of the Microsoft Office suite
• Experience in establishing professional and collaborative relationships with patients, doctors and insurance providers
• Certification as a diabetes educator, nutritionist, physical therapist or other specialty is a plus

Requirements:

• License: Any state
• Schedule: Shift: 8 hours (8:00 a.m. - 4:30 p.m.) with a 30-minute unpaid lunch
• Experience requirements:
  • Knowledge of IHS computerized systems (RCIS, RPMS, EHR, iCARE)
  • Familiarity with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
  • Understanding of medical coding systems (ICD, CPT-R, HCPCS, ADA Codes)
  • Knowledge of Medicare and Medicaid program benefits
  • Experience with case management and care coordination

Native American Preference: Preference in filling vacancies is given to qualified Native American candidates in accordance with federal law (Title 25, USC Section 472). Form BIA-4432 should be submitted with the application. For more information about Native American Preference in employment please visit https://www.bia.gov/jobs/Indian_Preference

Equal Opportunity Employer: Tribal Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. We value the skills, experience, and dedication that veterans bring to the workplace and qualified veterans are encouraged to apply. Tribal Health is also committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application procedures. If you need assistance or an accommodation due to a disability, please let us know during the application process.

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