Case Manager, Saint Francis

Description

The Center for Community Health (CCH) represents an exciting opportunity for Tulsa. The goal is to improve health disparities in the Tulsa community, decrease re-admission rates and inappropriate emergency room usage, and increase the use of primary care providers to improve patient health outcomes. The Case Manager (CM) is a team member to help the CCH attain its program success and to improve the health of patients.

Examples of Duties

Provides case management services for Center for Community Health clients coordinate referrals to community agencies for additional assistance, treatment, and continuity of care. Completes electronic documentation of each patient contact. CMs will work closely with medical providers and primary case management teams at SFHS and other agencies to improve patient care and outcomes. CMs will primarily work out of SHFS patient rooms and have office space at SFHS. CMs will implement effective strategies for linking high risk uninsured and underinsured clients to primary care/medical homes; increase access to appropriate health care and community-based services; assist individuals in improving health status; and promote behavior change in using the health care delivery system.

The following functions represent most of the duties performed by the position but is not meant to be all-inclusive or prevent other duties from being assigned when necessary.

ESSENTIAL JOB FUNCTIONS (95% of Time):
1. Create a trusting, comfortable, and respectful environment that fosters partnership and engagement with high risk clients from all backgrounds.
2. Provide focused case management by linking clients to the most appropriate venue for entry into the health care delivery system to include addressing the social determinants of health: transportation, primary care provider, food, utilities, health insurance, medications, housing, domestic violence, and access to internet, phone, and identity.
3. Coordinates care with SFHS physicians, case management, and other staff to provide coordinated care for patients. Works with a multidisciplinary health care provider team. Participate in weekly meetings and visit identified patients in the hospital before discharge. Must have ability to work quietly and respectfully in a shared workspace.
4. Coordinates as needed with Tulsa Health Department services and community partner resources.
5. Participates and attend regularly scheduled supervision meetings; be prepared to share both successes and pitfalls of case management.
6. Provide culturally and linguistically appropriate services to assigned clients.

7. Maintain complete and accurate documentation of all activities and reports through
computerized data entry in accordance with program standards, guidelines and THD
requirements. This includes preparing and submitting paperwork, such as, Workflow List,
Enrollment Questionnaires, Patient Summaries, and Weekly Patient List.
8. Attend regular peer group meetings for networking and information sharing for optimal care
management and navigation.
9. Other duties as assigned including those required to fulfill activities in support of public health
emergency operations.

SECONDARY JOB FUNCTIONS (5% of Time):
1. Participates in staff meetings, quality assurance activities, and in-service trainings.
2. Completes monthly time sheet and mileage forms.

Typical Qualifications