RN Managed Care

To assist in the coordination, facilitation, and case management of patients transferring from the Cherokee Nation Health System to another healthcare facility. Collaborating with personnel at all levels within the Cherokee Nation Health System and other healthcare facilities to coordinate smooth and effective patient transfers and transitions, ensuring appropriate follow-up and repatriation into the Cherokee Nation Health System. Acts as Clinical liaison for Contract Health Services by overseeing and assisting with review of referrals from Cherokee Nation Health System.

EDUCATIONAL REQUIREMENT

Valid Oklahoma State Licensure to practice as a Registered Nurse (RN); no substitutions.

EXPERIENCE REQUIREMENT

At least three (3) years’ experience in a related field.

COMPUTER SKILLS

An individual should have knowledge of database software, Human Resources systems, Internet software, order processing software, spreadsheet software, and word processing software.

CERTIFICATES, LICENSES, REGISTRATIONS

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. Registered Nurse (RN) Oklahoma licensure required. Must possess and maintain Cardiopulmonary Resuscitation (CPR) and Basic Life Support (BLS). CPR and BLS will be provided upon hire and a 30-day grace period of certification is lapsed to renew.

OTHER SKILLS AND ABILITIES

Must have excellent computer skills, statistical analysis, and critical thinking. Must possess knowledge of nursing process and have a working knowledge of the Oklahoma Board of Nursing Act rules and regulations. Must have the ability to be flexible, organized, and to function in stressful situations.

OTHER QUALIFICATIONS

Employee must not 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).

Member of American Nurses Association (AHAO), Oklahoma Nurses Association (ONA), Department specific organizations, Nurse Executive Memberships and committees on local, state, and national levels. Knowledge of pre-admissions/transfer reviews to be able to determine the anticipated length of stay and to avoid denials through proper screening. Knowledge of concurrent review and applying criteria for admission and continued stay review. Knowledge of coding systems used and to be able to refer to resources available for optimal collections (CPT, ICD, and the DRG).

PHYSICAL DEMANDS

While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to stand; walk; sit and reach with hands and arms. 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 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT

The noise level in this environment is usually moderate.