Alaska Native Tribal Health Consortium
Purchased Referred Care Clinical Manager
Alaska Native Tribal Health Consortium, Anchorage, Alaska, United States, 99507
The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
Cost-Share Dental and Vision Insurances.
Discounted Pet Insurance.
Retirement Contributions with Pre-Tax or Roth options into a 403(b).
Retirement Match and Discretionary. ANTHC matches up to 5%, with a 3% discretionary contribution after one year of employment into a 401(a).
Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
Twelve Paid Holidays.
Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment.
Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
Flexible Spending Accounts for Healthcare and Dependent Care.
Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
On-Site Child Care Facility with expert-designed classrooms for early child development and preschool.
Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
On-Site Training Courses and Professional Development Opportunities.
License and certification reimbursements and occupational insurance for medical staff.
Gym Access to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
Emergency Travel Assistance.
Education Assistance or Education leave eligibility.
Discount program for travel, gym memberships, amusement parks, and more.
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary:
Under limited supervision, provides guidance to clinical component of the Purchased Referred Care team, and supports the operations of inpatient, outpatient and specialty clinics. Assists with departmental reporting; oversees the use of departmental resources; identifies measurable outcomes; monitors, trends, and reports results.
Responsibilities:
Provides leadership, direction, and guidance to assigned staff.
Develops goals and priorities in conjunction with employees, and assigns tasks and projects.
Monitors departmental operations and procedures.
Facilitates processes that result in the continuous quality improvement of the clinical component of department’s productivity, effectiveness, and accuracy related to the referral and emergent authorization process.
Assists with quantitative and qualitative data collection for special and ongoing projects.
Provides clinical direction, guidance, and technical skills to staff. Assigns nursing case management caseloads.
Meets regularly with staff to resolve workload and technical issues.
Develops staff skills and training plans.
Implements corrective actions and conducts performance evaluations.
Serves as a role model for the staff and is capable of performing the duties of a Purchased Referred Care (PRC) Case Manager.
Develops systems to monitor admissions and transfers to non-I.H.S. facilities and ensures timely case reviews.
Analyzes patient records to determine PRC authorization of admissions, treatment, and length of stay in health care facilities to comply with federal guidelines, policies and procedures governing the use of PRC services.
Develops guidelines and protocols for the assessment of reauthorization for continued stay or transition of care to Alaska Native Medical Center (ANMC) or other health care facility, taking into consideration alternate health resources, availability of beds at ANMC, and other relevant factors.
Analyzes trends and evaluates program requirements and resource allocation.
Compiles and maintains reports and statistical information for evaluation, planning, and outcome improvement. Reviews patient referrals to ensure requested services falls within medical priorities and the use of direct Indian Health Service (IHS) resources prior to use of PRC.
Works closely with the PRC Medical Claims Supervisor and other key PRC staff in assessing and implementing departmental workflows to ensure efficient processing of referrals and claims.
Coordinates with ancillary staff, discharge care coordinators, and transfer care center staff. Serves as a liaison between ANMC departments, various Regional organizations, and State and Federal agencies; serves on committees, task forces, and other groups.
Provides guidance, training, and education to the medical staff and outside agencies in all issues related to PRC.
Performs other duties as assigned.
Other information:
KNOWLEDGE and SKILLS
Knowledge of professional nursing care principles, practices, and procedures to assess patient care.
Knowledge of case management auditing, theories, practices, and processes.
Knowledge of Indian Health Services (IHS), Alaska Tribal Health System (ATHS), and Alaska Native culture(s) and politics.
Knowledge of healthcare terminology, anatomy, physiology and concepts of diseases.
Knowledge in conducting and reviewing medical records for medical necessity.
Knowledge of PCS, ICD-10-CM, and HCPCS nomenclature, and coding rules and guidelines.
Knowledge of applicable federal, state, county, and local laws, regulations, and requirements.
Skill in developing and implementing strategic plans, goals, and procedures.
Skill in effectively managing staff, and delegating tasks and authority.
Skill in establishing and maintaining cooperative working relationships with others.
Skill in assessing and prioritizing multiple requests by patients, families, and team members.
Skill in utilizing evidence based practice to develop the plan of care and interventions.
Skill in assessing and prioritizing multiple tasks, projects and demands.
Skill in written and oral communications.
Skill in operating a personal computer utilizing a variety of software applications including Microsoft Word, Excel, PowerPoint.
MINIMUM EDUCATION QUALIFICATION:
Bachelor’s Degree in nursing or progressively responsible work experience may be substituted for nursing education on a year for year basis.
MINIMUM EXPERIENCE QUALIFICATION:
Non-supervisory – Five (5) years of nursing including hospital and/or case management. An equivalent combination of relevant education and/or training may be substituted for experience.
AND
Supervisory – Two (2) years of supervisory experience.
PREFERRED EXPERIENCE QUALIFICATION:
Experience in the Alaska Tribal Health System preferred.
PREFERRED CERTIFICATION QUALIFICATION:
Current registered nurse license in the State of Alaska.
Current Basic Life Support (BLS) card.
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ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
Cost-Share Dental and Vision Insurances.
Discounted Pet Insurance.
Retirement Contributions with Pre-Tax or Roth options into a 403(b).
Retirement Match and Discretionary. ANTHC matches up to 5%, with a 3% discretionary contribution after one year of employment into a 401(a).
Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
Twelve Paid Holidays.
Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment.
Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
Flexible Spending Accounts for Healthcare and Dependent Care.
Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
On-Site Child Care Facility with expert-designed classrooms for early child development and preschool.
Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
On-Site Training Courses and Professional Development Opportunities.
License and certification reimbursements and occupational insurance for medical staff.
Gym Access to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
Emergency Travel Assistance.
Education Assistance or Education leave eligibility.
Discount program for travel, gym memberships, amusement parks, and more.
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary:
Under limited supervision, provides guidance to clinical component of the Purchased Referred Care team, and supports the operations of inpatient, outpatient and specialty clinics. Assists with departmental reporting; oversees the use of departmental resources; identifies measurable outcomes; monitors, trends, and reports results.
Responsibilities:
Provides leadership, direction, and guidance to assigned staff.
Develops goals and priorities in conjunction with employees, and assigns tasks and projects.
Monitors departmental operations and procedures.
Facilitates processes that result in the continuous quality improvement of the clinical component of department’s productivity, effectiveness, and accuracy related to the referral and emergent authorization process.
Assists with quantitative and qualitative data collection for special and ongoing projects.
Provides clinical direction, guidance, and technical skills to staff. Assigns nursing case management caseloads.
Meets regularly with staff to resolve workload and technical issues.
Develops staff skills and training plans.
Implements corrective actions and conducts performance evaluations.
Serves as a role model for the staff and is capable of performing the duties of a Purchased Referred Care (PRC) Case Manager.
Develops systems to monitor admissions and transfers to non-I.H.S. facilities and ensures timely case reviews.
Analyzes patient records to determine PRC authorization of admissions, treatment, and length of stay in health care facilities to comply with federal guidelines, policies and procedures governing the use of PRC services.
Develops guidelines and protocols for the assessment of reauthorization for continued stay or transition of care to Alaska Native Medical Center (ANMC) or other health care facility, taking into consideration alternate health resources, availability of beds at ANMC, and other relevant factors.
Analyzes trends and evaluates program requirements and resource allocation.
Compiles and maintains reports and statistical information for evaluation, planning, and outcome improvement. Reviews patient referrals to ensure requested services falls within medical priorities and the use of direct Indian Health Service (IHS) resources prior to use of PRC.
Works closely with the PRC Medical Claims Supervisor and other key PRC staff in assessing and implementing departmental workflows to ensure efficient processing of referrals and claims.
Coordinates with ancillary staff, discharge care coordinators, and transfer care center staff. Serves as a liaison between ANMC departments, various Regional organizations, and State and Federal agencies; serves on committees, task forces, and other groups.
Provides guidance, training, and education to the medical staff and outside agencies in all issues related to PRC.
Performs other duties as assigned.
Other information:
KNOWLEDGE and SKILLS
Knowledge of professional nursing care principles, practices, and procedures to assess patient care.
Knowledge of case management auditing, theories, practices, and processes.
Knowledge of Indian Health Services (IHS), Alaska Tribal Health System (ATHS), and Alaska Native culture(s) and politics.
Knowledge of healthcare terminology, anatomy, physiology and concepts of diseases.
Knowledge in conducting and reviewing medical records for medical necessity.
Knowledge of PCS, ICD-10-CM, and HCPCS nomenclature, and coding rules and guidelines.
Knowledge of applicable federal, state, county, and local laws, regulations, and requirements.
Skill in developing and implementing strategic plans, goals, and procedures.
Skill in effectively managing staff, and delegating tasks and authority.
Skill in establishing and maintaining cooperative working relationships with others.
Skill in assessing and prioritizing multiple requests by patients, families, and team members.
Skill in utilizing evidence based practice to develop the plan of care and interventions.
Skill in assessing and prioritizing multiple tasks, projects and demands.
Skill in written and oral communications.
Skill in operating a personal computer utilizing a variety of software applications including Microsoft Word, Excel, PowerPoint.
MINIMUM EDUCATION QUALIFICATION:
Bachelor’s Degree in nursing or progressively responsible work experience may be substituted for nursing education on a year for year basis.
MINIMUM EXPERIENCE QUALIFICATION:
Non-supervisory – Five (5) years of nursing including hospital and/or case management. An equivalent combination of relevant education and/or training may be substituted for experience.
AND
Supervisory – Two (2) years of supervisory experience.
PREFERRED EXPERIENCE QUALIFICATION:
Experience in the Alaska Tribal Health System preferred.
PREFERRED CERTIFICATION QUALIFICATION:
Current registered nurse license in the State of Alaska.
Current Basic Life Support (BLS) card.
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