Job Purpose & Position Overview: This position is responsible for providing Case Management services for outpatients in the Twelve Clans Unity Hospital. This includes patients referred to the private sector through the WCHS Purchase Referred Care Program.

Specific Job Duties/Responsibilities:

• Demonstrates the WCHS core Mission, Vision and Values.
• Communicates with providers to initiate/coordinate outpatient services/discharge planning needs for patients.
• Acts as a liaison to assure services are being provided to patients referred to private sector hospital for specialty referral care.
• Works closely with the IP Case Manager, ED Case Manager, PRC Case Manager and Hospital Social Worker.
• Works closely and establishes strong relationships with the outpatient nurses and providers.
• Has clear knowledge or how the outpatient clinic works and is able to help fill in as needed or when requested by the supervisor.
• Works closely with Patient Referred Care (PRC) and understands the principles.
• Ensures those with chronic conditions and high utilization of services are assessed and followed.
• Determines clients' requirements by completing intake interviews; determining need for therapeutic medical, psycho-social, and psychiatric evaluations; reviewing therapist evaluations, treatment objectives, and plans.
• Establishes treatment programs by setting schedules and routines; coordinating services being provided; arranging resources, including transportation and escort.
• Monitors cases by verifying clients' attendance; observing and evaluating treatments and responses; advocating for needed services and entitlements; obtaining additional resources; intervening in crises; providing personal support.
• Maintains clients' records by reviewing case notes; logging events and progress.
• Improves staff competence by providing educational resources; balancing work requirements with learning opportunities; evaluating the application of learning to changes in treatment results.
• Improves treatment results by studying, evaluating, and re-designing processes; implementing changes; rewriting policies and procedures.
• Improves financial status by analyzing results; monitoring variances; identifying trends; recommending actions to management.
• Reviews and recommends current and future quality measure to ensure appropriate outcomes and targets are achieved.
• Meets budget by monitoring expenses; implementing cost-saving actions.
• Prepares reports by collecting, analyzing, and summarizing treatment and results data and trends; compiling statistics; completing grant and subsidy applications.
• Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Enhances department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
• Maintains knowledge in the utilization review process.
• Performs back up for other case management/utilization review and social work staff during times of vacation and sick leave.
• Performs other duties as assigned.

Required Qualifications/Skills:

• Licensed Practical Nurse Degree required; Associates or Bachelor's Degree preferred and one year proven experience as a Case Manager or combination of education and applicable experience
• Must have excellent communication skills and can relate easily to both patient and providers.

Training Requirements:

• N/A

Physical Requirements:

• Normal to light office work which includes the ability to lift up to 10 lbs.
• Regularly required to walk, stand, and sit for extended periods of time and use hands to operate computer keyboard, phone, and various office equipment.

Cognitive Requirements:

• Reading, writing, calculating
• Above average social interaction skills

• Reasoning/Analysis
• Works with minimal to no supervision

Language Requirements:

• Must possess the ability to read, write, and speak the English language fluently.
• Must be able to continually and effectively employ professional verbal and written communications skills.

Certificates, Licenses & Registrations:

• All applicants will comply with 45 CFR 1301, Subpart D, Section 1301.31, C and D, which require all prospective employees to sign a declaration prior to employment regarding all arrests and convictions of child abuse or violent felonies and to comply with PL 101-630 and PL 101-637 regarding criminal records check.

WCHS is an equal opportunity employer. Employment practices are free of discrimination. As provided by Federal Law, all qualified Native American applicants shall receive preference over Non-Native American applicants. In the absence of qualified Native American applicants, consideration will be given to all other applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, veteran status, genetic information, disability or any other reason prohibited by law in provision of employment opportunities and benefits.

Please note the position description duties, responsibilities, and activities may change at any time with or without notice.

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