Provides care management in the ambulatory health care setting according to Cherokee Nation standing orders, policies, and guidelines. Participates as a crucial member of the care team which may include a provider, licensed practical nurse, medical assistants, and the patient panel.

Routine duties shall include providing health care services to individuals eligible for services in accordance with the self-governance compact and funding agreement between the Cherokee Nation and the United States executed under the authority of the Indian Self-Determination and Education Assistance Act. Completes pre-visit planning for scheduled patients. Communicates the patient's needs and recommended treatment to the staff on their team. Maintains & updates the team's patient panels. Identifies, creates, & maintains panels of high-risk subpopulations for care management. Tracks performance measures monthly and shares with the team, staff, and patients. Participates in ongoing quality improvement activities using the Model for Improvement. Contacts patients for follow-up diagnostic tests, referrals, appointments, or medical follow-up as appropriate. Schedules nursing visits for follow-up. Tracks and follows up on referrals. Provides patient education and self-management support. Triages patients on the team's panels who call or walk in and directs them appropriately. Documents observations, assessments, nursing interventions, treatments, and referrals according to CN documentation standards. Provides direct nursing care back up as the team needs dictate. Provides Human Resources with a copy of all licensures, certifications, renewal of licensures, and certifications upon receipt thereof. Other duties may be assigned.

Specific to Cancer Care Case Management:

Reviews patient medical records to determine eligibility for grants and other programs according to applicable rules, regulations, and guidelines. Plans, develops, and implements assurance monitors for the designated grant or other programs. Ensures validity, quality, and timeliness in grant and other program reporting submissions as required. Tracks and follows all patients receiving abnormal screening result(s) and in collaboration with the health care provider, assesses needs, issues resources, and goals.

Specific to Purchased and Referred Care (PRC) Case Management:

Reviews patient medical records and PRC referrals to determine eligibility for the program(s) according to applicable rules, regulations, and guidelines. Plans, develops and implements quality assurance monitors for the PRC program as assigned. Makes inquiries to obtain alternate resources for services recommended for patients by the provider. Consults with staff and multidisciplinary health care providers as necessary to facilitate appropriate decision-making in referral services. Screens authorizations and reports those exhibiting potential catastrophic cost to the appropriate party(ies). Enters orders as received by the Orders Management Team.

SUPERVISORY RESPONSIBILITIES

No supervisory responsibility.

EDUCATIONAL REQUIREMENT

Associates degree from a 2-year college or technical school in Nursing; no substitutions.

EXPERIENCE REQUIREMENT

No additional experience.

COMPUTER SKILLS

An individual should have knowledge of Database software; Spreadsheet software, and Word Processing software.

CERTIFICATES, LICENSES, REGISTRATIONS

Must possess a license as a Registered Nurse (RN) from the Oklahoma Board of Nursing (OBN) or possess a multistate RN license accepted by the OBN, no substitutions. Must maintain license throughout employment. Must be certified in Basic Life Support (BLS) and maintain throughout employment. Can be obtained during orientation. Must be certified in Advanced Cardiac Life Support (ACLS) and maintain throughout employment. If not certified, ACLS certification must be obtained within six (6) months of hire.

Specific requirements for departments:

Surgical Clinic: Advanced Cardiac Life Support (ACLS)

Pediatric Advanced Life Support (PALS)

National Institutes of Health Stroke Scale (NIHSS)

Interventional Radiology: Advanced Cardiac Life Support (ACLS)

Pediatric Advanced Life Support (PALS)

National Institutes of Health Stroke Scale (NIHSS)

Dysrhythmia Course

A driver's license may be required to work in some departments. If so, the applicant/employee must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating.

OTHER QUALIFICATIONS

The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG’s Cumulative Sanction Report, or the GSA’s List of Excluded Providers, or listed on the OIG’s List of Excluded Individuals/Entities (LEIE).

Must meet and maintain pre-employment and periodic background investigation and adjudication for child care. Educated on and compliant with HIPAA regulations; maintains strict confidentiality of client information.

PHYSICAL DEMANDS

While performing the duties of this job, the employee is frequently required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl and taste or smell. The employee must occasionally lift and/or move up to 50 pounds.

WORK ENVIRONMENT

While performing the duties of this Job, the employee is occasionally exposed to fumes or airborne particles and toxic or caustic chemicals. The noise level in the work environment is usually moderate.