About Job

We are currently looking for a Full Time Inpatient Case Management/Social Worker Manager to join our Inpatient Case Management and Social Worker Team located at the Chickasaw Nation Medical Center.

Summary:

Coordinates and facilitates the provision of patient care on a day-to-day basis. Utilization review– determining whether the patient meets pre-established evidence-based criteria to support the level of care being delivered. Transitional planning (discharge planning) – in conjunction with utilization review, to ensure that services are provided in the most appropriate setting as delineated in the standards and guideline of regulatory and accreditation agencies.

Responsibilities:

Supervises utilization review, care coordination, discharge planning and supervision for inpatient case managers and social workers on the acute care areas of emergency room, acute care, ICU and Women’s Care/OB
Ensures data collection and submission of monthly/quarterly/annual reports as directed to the Senior Manager of Care Coordination for the utilization review and discharge planning process
Provides unit coverage in absence of assigned case manager and/or discharge planner
Oversees the daily management of case management and social work functions within the CNDH by assessing, planning and organizing social services
Works to integrate social work and case management activities within the care coordination process, ensuring services are provided in the most appropriate setting
Assists in the system-wide preparation for pre- and post- JCAHO survey activities
Oversees hiring, orientation, performance development, training and annual reviews for case managers and social workers
Provides leadership in the development of policies, procedures, and protocols related to inpatient case management and social work
Ensures that case management and social work activities are ethical and of value to the patient, their family, and the providers of care both within and outside the health system
Maintains a daily log of case management activities
Conducts chart audits and record reviews for the business office, admissions/registration, and health information management
Manages care coordination for Native American patients by assessing, planning, and organizing health care services within a framework of established guideline/protocols, health status of patients, and available funds/resources
Generates and faxes/copies patient protected health information necessary for continuation of care to outside healthcare facilities and/or providers, ensuring that all records needed for this process are accurate and valid, while maintaining patient confidentiality, security and integrity of data
Maintains confidentiality, security, and integrity of data and information in accordance with HIPAA regulations
Ensures continuity of care
Identifies and screens cases, determines the availability of community resources, evaluates that status of the patient’s mental and physical capabilities and provides coordination
Compiles, processes, and maintains medical records of patients in a manner consistent with medical, administrative, ethical, legal and regulatory requirements and performed in accordance with policy and procedure
Shares clinical information with providers and other health care professionals
Serves as a resource to identify all possible patient resources and potential payer sources
Works with the family to identify possible alternate funding such as Medicare, Medicaid, veterans’ health benefits, disability, vocational rehabilitation, tribal programs/services
Serves as a resource for nurses, providers, and the patient/family during the care coordination process and discharge planning. Facilitates referrals to outside agencies such as home health agencies, need for durable medical equipment (DME), hospice, nursing homes, long term care, etc.
Assists social work services with discharge planning and clinical interpretations as needed
Establishes a working relationship with other IHS providers and hospitals; external providers and hospitals; tribal health programs providers and hospitals; home health agencies; community outreach programs; and customers of the Chickasaw Nation Department of Health
Works closely with hospitalist and supporting staff to make appropriate referrals for continued follow-up and care following discharge from the acute care setting
Participates in a multidisciplinary team that contributes to the development of a comprehensive plan of care
Serves on hospital committees as assigned
Provides guidance for the inpatient case managers concerning work to be accomplished
Oversights for the utilization review process, including secondary review and provider reviews, patient letter notification for Condition Code 44, Important Message from Medicare, and Observation Status
Conducts concurrent utilization review activity
Reviews medical record to ensure that patients have a condition that requires treatment (indication for hospitalization element) and that the treatment can be safely provided only in the appropriate inpatient setting (treatment element)
Collects and verifies third party Medicare, Medicaid and or Private insurance and obtains appropriate authorization signatures
Reviews and analyzes medical records to assess whether planned surgical procedures are medically necessary and admission to the hospital is justified
Provides activity data review for reporting on a quarterly basis
Assists in responding to the state quality improvement organization (QIO) queries and studies
Monitors patients assigned to 23-hour observation status and when necessary
Tracks potentially avoidable days and readmissions for reporting to the Utilization Review Committee
Consults with the physician advisor when indicated by review results
Assists in identifying activities and data collection for performance improvement
Participates in Revenue Cycle Management and demonstrates awareness of the need to control expenses
Acts as a resource/consultant to hospital and medical staff in the care of care coordination and discharge planning
Assists in orientation and education of department personnel
Provides feedback and focused educational programs on the results of admission screening reviews to affected staff and providers
Maintains files, logs, and records
Ensures employees and resources complete assigned training and development
Maintains knowledge of and enforce all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
Plans staff to meet operational needs
Develops, communicates, monitors location- or function-specific procedures and guidelines
Monitors and improves work performance of assigned teams as a whole and as individuals
Meets operational goals by establishing productivity, quality and service standards, resolves operational problems and identifies work process improvements
Ensures all outcomes and deliverables meet organizational goals, objectives, and quality standards
Provides first class customer service - courteous and helpful to all internal and external customer types
Answers questions in a courteous and professional manner
Greets and engages with a smile
Determines needs, seeks positive experience and outcomes
Completes all training and development requirements and participates in continuing education opportunities
Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
Maintains general upkeep of work area and maintains a safe environment
Maintains and promotes professionalism
Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
Adheres to Chickasaw Nation dress code standards
Maintains knowledge of and follows all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
Performs all other duties as assigned

Competencies:
Essential:

Ability to collaborate with and or coordinate efforts of others
Ability to adapt to new technological environments
Ability to prepare clear and concise role-specific reports
Ability to accept criticism and constructive feedback
Ability to make sound judgements
Demonstrated ability and skill in auditing and interpreting medical records
Ensures compliance
Maintaining a high level of confidentiality and using discretion and discernment
Resolves conflicts among personnel, projects and schedules
Must be able to exert analytical and critical thinking skill
Demonstrates critical thinking, long-term planning, and leadership skills and an understanding of natural resources, plants, land management and maintenance skills
Delegates to appropriate personnel and follows-up to ensure required results and standards are met
Must be detail-oriented
Must be self-motivated
Ability to work independently
Honesty, truthfulness, reliability, accountability
Able to read, understand, apply, and retain knowledge of Chickasaw Nation, departmental, divisional and all other rules, regulations, policies, procedures and guidelines
Knowledge of federal, state and local law and law enforcement regulations
Knowledge of industry best practices
Learn and apply Health Insurance Portability and Accountability Act (HIPAA), Privacy Act, Federal Advisory Committee Act (FACA), Federal Tort Claims Act (FTCA), Freedom of Information Act, Compliance Standards, Joint Commission Accreditation, and other various regulations
Knowledge and understanding of third-party applications
Basic project management skills, including communication, scope, and schedules
Understanding of business fundamentals, processes, and documentation
Ability to choose solutions to challenges and make informed decisions by collecting relevant information and data and considering multiple viewpoints, cost-benefit, core values, etc.
Strong leadership, communication, and interpersonal skills, with the ability to lead and motivate team members
Establishes professional working relationships as appropriate
Ability to plan, organize and follow through on assignments
Interpersonal skills to motivate, investigate, inspire
Writes effective communications with team, departments, guests and management
Ability to write clearly, concisely, and accurately (e.g. Reports, business correspondence, and procedure manuals demonstrating logic focus, critical thinking, and clarity with a diverse group of people, including employees, clients, general public, outside entities, administrative staff, and co-workers)

Skills:
Essential:

Intermediate computer skills
Intermediate skill using Excel for multiple purposes
Must be flexible and be able to adapt to last minute changes
Must be able to operate a computer and/or other equipment related to specific role (i.e. automated currency counters, calculator, projector, binding machine, other related office equipment)
Excellent Phone Skills
Intermediate skill using Word for multiple purposes

Experience:
Essential:

2 years directly related experience

Education:
Essential:

Bachelor's of Nursing

Credentials:
Essential:

Pass general background check
Unrestricted Oklahoma Registered Nurse License
Basic Life Support (BLS)

Nonessential:

Certified Case Manager (CCM)

Essential:

Must maintain BLS certification or obtain within one (1) month of hire, if not current

Working Conditions:
Essential:

Works in a hospital or clinic environment
Stressful environment due to any or a combination of deadlines, pressures, multiple tasks, lines of communication, risks, speed of operations, etc.
Potential exposure to contagious diseases
May be required to assist individuals with unmanaged emotions
Standing up to 75% of shift
Walking up to 75% of shift
Frequently bend, kneel, stoop, push, reach
May work evenings, weekends or holidays
Sometimes lift and or carry up to 50 lbs
Pass pre-employment drug test