Complexity of Duties
Guidelines consist of professional standards of practice, medical policies and procedures. Must comply with Compliance Plan, Utilization Review Plan, State and Federal guidelines, CMS, FPM, DHHS, PHS, and IHS regulations. These guidelines are not always specifically applicable to the individual patient or situation and independent judgment is required in selecting the most appropriate guideline, and applying the intent. Requirements are complex in that they require comprehensive skills in Social Services and Case Management and have sufficient knowledge of medicine to evaluate patient care. This may involve difficult interactions with the clinical staff, case managers, care managers and insurance payers and require maximum skills in diplomacy and judgement.
Contact with Others
Interacts frequently with coworkers, hospital staff, patients and other health professionals for the purpose of exchanging information, obtaining, and/or providing assistance. Tact, courtesy, and professional conduct are required to maintain positive working relationships. Utmost sensitivity and confidentiality is required when dealing with patients and families.
The incumbent has access to high confidential patient medical and personal information. The Privacy Act of 1974 mandates that the incumbent shall maintain complete confidentiality of all administrative, medical and personnel records and all other pertinent information that comes to the individual's attention or knowledge. The Privacy Act carries both civil and criminal penalties for unlawful disclosure of records. Violation of such confidentiality shall be cause for corrective action.
Work is mostly sedentary, yet requires walking, standing, bending, and carrying light items such as files and manuals. Will be subject to frequent interruptions requiring varied responses, which can cause distractions therefore, the incumbent must possess the ability to differentiate and prioritize many tasks at once.
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 patient. Incumbent works under the administrative supervision of the Primary Care Assistant Director of Care Management, who controls the Department's functional duties and provides specific instructions on assignments. Work is primarily reviewed in terms of overall quality and efficiency of service provided to patients and staff by the Primary Care Assistant Director of Care Management.
Office environment with majority of work done sitting and talking on the phone. Must be flexible in working hours. Work is performed in the clinic setting. Incumbent may be exposed to communicable diseases. 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.
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.