Social Worker / RN Case Manager

Tuba City Regional Health Care • Tuba City, AZ

173d

About The Position

Incumbent serves as an Outpatient/Inpatient Social Worker/Registered Nurse (RN) Case Manager for TCRHCC and Sacred Peaks Healthcare Center (SPHC) and is responsible for direct supervision and supportive contact for the specific group of identified high-risk patients. The Social Worker/RN Case Manager is responsible for designing and managing a continuum of care focusing on empowering clients to achieve demonstrable outcomes and self-sufficiency.

Requirements

• Education: MSW Social Worker: Master's Degree in Social Work (MSW), OR RN Case Manager: Associates degree in Nursing, must obtain bachelor's in nursing within 2 years of hire
• License/Certification: Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association throughout employment MSW Social Worker: Licensed Master Social Worker (LMSW). A valid, current, full and unrestricted Professional License to practice LMSW or LCSW in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States RN Case Manager: A valid, current, full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States
• Experience: Must have a minimum of three (3) years of experience in the clinical care setting Experience and knowledge of discharge planning, case management, or utilization review processes. Demonstrate knowledge of electronic health record systems
• Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas: Positive working relationships with others Possession of high ethical standards and no history of complaints Reliable and dependable; reports to work as scheduled without excessive absences Effective verbal & written communication skills Team management focus promoting a positive and pro-active approach to problem resolution Completion of satisfactory and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC

Responsibilities

• Coordination of service specific assessments, service planning and enrollment
• Comprehensive and client-centered service planning and coordination
• Resource acquisition facilitated referrals and linkages
• Consistent and ongoing case consultation with all direct service providers
• Identifying patient through consultation and high-risk diagnoses
• Perform UR coordination functions by ensuring medical necessity of preadmission, admission, continued stay, cost containment and discharge planning on patients admitted TCRHCC
• Accountable for the education, knowledge and process related to the Recovery Audit Contractors role in inpatient and outpatient reimbursement as related to the impact on TCRHCC revenue
• Reviews TCRHCC inpatient admissions for medical necessity and is the lead for UR Committee reviews in collaboration with the Medical Staff representative
• Assists with the development of department reports, policy/procedures manuals, and program objectives
• Assists with special projects as assigned
• Conducts system and procedural efficiency evaluation to determine progress, performance, and conformity with program requirements
• Follows up outside inpatient referrals for continued follow-up (i.e., appointments and PHN referrals)
• Provides coverage for the inpatient units-ACU, PEDS, ICU, OB, and ER to include Outpatient Clinics
• Manages care of prioritized TCRHCC/SPHC outpatient/inpatient based upon consultation from providers within the TCRHCC/SPHC healthcare delivery system
• Facilitate communication and coordination between members of the health care team, involving the client in the decision-making process in order to minimize fragmentation in the services
• Develops with the patient/family and multidisciplinary team (including service area and/or other non-TCRHCC/SPHC providers as appropriate) a care and service delivery plan based upon the needs identified and available provider and financial resources of the patient and provides consistent and ongoing case consultation with all direct service providers
• Prepares patient and family for discharge from case management when services are no longer required
• Arranges for any ongoing support/direct care services that the patient will need post-discharge in coordination with discharge planners and other entities such as PHN, Community Health Representatives or Tribal Social Services
• Will be familiar with Advance Directives and be a resource person for patients and families; facilitate informed choice, consent, and decision-making
• Promote use of evidence-based care, as available, in conjunction with the MCG Care Guidelines
• Pursue professional excellence and maintain competence in practice
• Serves as the outpatient/inpatient coordinator, such as: The primary contact for outpatient/inpatient in obtaining beds for admissions both within and outside of TCRHCC/SPHC
• Collaborates with provider and nursing personnel to ensure admissions are conducted seamlessly and without delay of patient care
• Collaborates with provider, nursing personnel and patient benefits coordinators that all admission documentation is complete and all referrals for third party resources are complete prior to the departure of patients
• Will be committed to Case Management Services and have some assignments with Purchased and Referred Care (PRC) formally known as Contract Health Services, providing assistance with the PRC Case Specialist
• Will share in coverage all units, inpatient and outpatient for staffing shortages
• Incumbents will be required to take call on scheduled weekends as deemed necessary
• Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield
• Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly
• Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee and external customer satisfaction
• Performs other duties as assigned

What This Job Offers

• Education Level: Master's degree
• Number of Employees: 1,001-5,000 employees