Tribal Option Case Management Support

Primary Function

Works under the direction and supervision of the Tribal Option Specialty Team Care Manger Lead, TO Care Manager Supervisor, Assistant Director of Care Management and the Director of Care Management. Provide a direct link for all communication between the member and the TO staff.  Create, develop, and nurture culturally appropriate interactions and connections with members, co-workers, and the community at large.  Primary duties will be to answer incoming telephone calls, assist with coordinating member appointments, filing, and message delivery, information retrieval, sending and receiving faxes, utilizing the copier to perform other standard office duties as assigned. 

Job Description

• Receives all phone calls with exceptional customer service while providing routine information to callers.
• Answers phone and directs calls to appropriate staff member or team. Takes messages as required. Determines which staff members can handle and which need management. Personally, responds to non-technical questions regarding the department. 
• Greets members/visitors, makes necessary notifications, assists as necessary to facilitate contact with the appropriate persons, and directs to the correct team member. 
• Assists members by providing accurate information that meets the members needs the first time. 
• Works with members in a positive and courteous manner to establish and maintain effective working relationships. 
• Proficient in the use of the care management platform as well as the Electronic Health Record (HER).
• Assists with referral follow-up as needed when requested. 
• Maintains quality, safety, and infection control standards.
• Shares and receives information, opinions, concerns, and feedback in a supportive manner.
• Works collaboratively by building bridges, and creating rapport with team members within departments and across the organization.
• Works as an active participant in a team environment.
• In the event of a local public health emergency, employee may be assigned duties pertaining to the event.
• May be necessary to work when Administrative Leave is granted if patient care would be compromised.
• Completion of duties affects the efficiency with which the CIH provides service and therefore could have an indirect negative effect on member outcomes.
• Performs other duties as assigned.

Job Knowledge

• A practical knowledge of CIH’s organization and services, the basic rules and regulations governing visitors and member treatment, HIPPA and practical knowledge of standard procedures, and medical terminology. 
• Knowledge of typing and basic computer skills. 
• A good working knowledge of terms describing diseases, medical and surgical procedures, as well as, standard abbreviations used by medical/non-medical staff.
• A thorough knowledge of recording and referral procedures.
• Good communication skills to facilitate the relaying of necessary information to members of the TO team.
• Requires the ability to organize work, deal effectively with the public, and communicate effectively, both verbally and in writing.

Education/Experience

• A high school diploma or GED is required. 
• Completion of a medical terminology class is preferred. 
• A minimum of two years’ experience working in a clerical, administrative or health related field is preferred. 
• Position will require 6 months to become proficient in most phases of the job.

Complexity of Duties

This position is responsible for assisting in maximizing the available resources that best meets the constantly changing needs of the community. Must have the ability to interpret policy, laws and regulations in order to make decisions when a precedent is not available. Duties require the application of clinical judgment and problem solving skills in order to be effective.

Confidential Data

The provision of medical care requires that the incumbent maintain strict appropriate confidentiality regarding all patient information. The employee will have access to patient records and highly confidential information and must function with utmost integrity to safe guard this information. The employee complies with EBCI policy on confidentiality of patient records, Cherokee Indian Hospital Authority Confidentiality policy, HIPAA, 42CFR and other federal law requirements. Violations of confidentiality regulations may result in disciplinary action and other action as allowed by federal regulations.

Contact with Others

Interacts frequently with coworkers, hospital staff, patients, stakeholders and other health professionals for the purpose of exchanging information, obtaining, or providing assistance. Serves on various local, community, and health committees, boards and advisory councils, as appropriate. Tact, courtesy, and professional conduct are required to maintain positive working relationships. Utmost sensitivity and confidentiality is required when dealing with patients and families.

Customer Service

Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.

Mental/Visual/Physical Expectations

Job duties can be mentally and emotionally stressful at times given the complexity of the duties, management and supervision of staff and the clinical areas being addressed with the people being served. Close mental concentration and attention to detail are required. Physical activities require the ability to be mobile, sit, reach, bend, and be in front of groups and deliver training for extended periods of time. Some physical exertion and stamina is required such as required to transport training materials or to travel. Must have visual acuity, manual dexterity, and the ability to speak and hear. Must be able to lift 30 lbs.

• Position requires: stand (under 1/3 time); walk (under 1/3 time); sit (to 2/3 time); talk or hear (over 2/3 time).
• Weight lifted or force exerted: none.
• Special vision requirements: Close vision (clear vision at 20 inches or less).

Resourcefulness and Initiative 

The supervisor provides specific detailed roles covering all assignments. The employee does not deviate from the roles unless authorized, but is encouraged to be resourceful and inventive when meeting the needs of the member. Incumbent works under the administrative supervision of the TO Specialty Team Care Manager Lead/TO Care Manager Supervisor, who controls the Department’s functional duties and provides specific instructions on assignments. Receives general instructions on assignments from the TO Specialty CM Lead. The incumbent is responsible for initiating and following through on recurring clerical assignments. Work is primarily reviewed in terms of overall quality and efficiency of service provided to members and staff by the TO Specialty CM Lead.

Responsibility for Accuracy

Most errors would be detected with proofing and review procedures. Failure to properly manage and direct activities could result in ill will for the department, delays in patient treatment, and negative patient and community relations. Ineffective health planning could have adverse effects on the health status of the community by limiting access to necessary resources. Accuracy of data and research is critical in the allocation of tribal resources. Responsible for the adherence to policy and procedure. Inappropriate actions or inaccuracies in judgment could result in improper diagnosis and treatment, serious liability for the tribe, or more serious health risks to members.

Supervision Received

Works under the direct guidance of the TO Care Manager Specialty lead/TO Care Manager Supervisor, where goals, objectives, policies, and procedures are well defined. Works independently within applicable licensing regulations where latitude for creative thinking, initiative and discretion are given to achieve department goals and objectives.

Work Environment

Must be flexible in working hours. This position offers a hybrid work model, with the flexibility to work remotely or from the designated work space. Specific workdays and location will be determined in collaboration with the team, the TO Care Manager Specialty Lead, and TO Care Manager Supervisor. The incumbent may occasionally be required to perform care management duties and tasks within the clinical setting.  Incumbent is required to comply with Employee Health Program guidelines including current immunization status of identified communicable diseases and safety precautions are sometimes necessary, such as use of personal protective equipment as required by hospital policy. The work environment involves moderate risks of exposure to infectious disease, radiation, electrical hazards, irritant chemicals and explosive gases. Some travel is required. Infrequent overnight travel may be required for meetings or to attend training.