Location:
Klamath Falls, OR;Chiloquin, OR Exit Disclaimer: You Are Leaving www.ihs.gov
Type:
Tribal
Salary Range:
$82,859 to $144,821 / Per Year
Open Period:
12/4/2025 until filled
Summary:
POSITION OBJECTIVES
The RN Case Manager works collaboratively with providers and other members of the health care team to improve the health of patients with chronic conditions or complex needs. This position educates patients and families to help them manage their health care needs. The RN Case Manager facilitates communication, coordinates services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management. The RN Case Manager works for the KTHFS Wellness Center within a scope aligned with the Primary Care Clinical Program initiatives. Patient interactions may be in person, by telephone, or other electronic means.
More info about area:
https://klamath.org/todo/ Exit Disclaimer: You Are Leaving www.ihs.gov
Job Announcement Flyer:
OPEN FOR RECRUITMENT RN Case Manager 10-23.pdf [pdf - 315.66 KB]
Duties: General Case Management
Identifies patients who meet established criteria for care management (e.g. HgA1c > 8, elevated LDL and/or blood pressure, Mental Health Integration referral, complex resource needs).
Manage panel acute and chronic care needs as well as health maintenance, meeting clinic expectations for health maintenance standards.
Maintain accurate, complete, timely and professional documentation in health records. Documentation of all patient contacts required, including but not limited to telephone contact with any significant changes for provider to review.
Patient Evaluation
Assesses family, social, cultural characteristics.
Understands communication needs (e.g., vision, hearing).
Assesses behavioral and family risk factors.
Assesses barriers.
Screens for chronic disease (e.g. depression).
Reviews patient understanding of medication treatment.
Notify provider and appropriate personnel of emergent situations.
Chronic Disease Management
Utilizes a working knowledge of established care process models and other applicable standards of care.
Provides focused patient education using established content and tools.
Uses clinician approved and appropriately documented standing orders.
Establishes individualized care plan including treatment goals in collaboration with patients and consistent with medical plan of care.
Reviews care plan and assess progress toward treatment goals and barriers at each relevant visit.
Support Patient in Self-Management and Behavior Change Using Motivational Interviewing and Coaching
Assesses readiness to change.
Assesses and tracks patient capacity for and confidence in self-care.
Provides self-monitoring tools.
Provides or connects patients with support programs.
Assesses and supports patients in adopting healthy behaviors.
Assesses and arranges treatment for mental health and substance abuse problems.
Establishes process to monitor patient adherence to medical plan of care. Coordination of Care
Coordinates with care managers in other settings as appropriate.
Provides information on enabling services (e.g., transportation).
Maintains list of key community services agencies with contact information.
Provides information about recommended or available services and contacts.
Manage Populations, Disease Registries and Preventive Care
Qualifications: Minimum Qualifications: Failure to comply with minimum position requirements may result in termination of employment.
• REQUIRED to possess a current State License as a Registered Nurse. For out of state applicants; Oregon Registered Nursing Licensure required within 90 days of hire. (Must submit copy of Licensure with application.)
• REQUIRED to acquire and maintain ACLS certification for healthcare providers.
• REQUIRED to have basic computer skills, EHR experience, and knowledge of word processing software.
• REQUIRED to submit to annual TB skin testing and adhere to KTHFS staff immunization policy in accordance with the Centers for Disease Control immunization recommendations for healthcare workers.
• REQUIRED to submit to a background and character investigation, as per Tribal policy. Following hire must immediately report to Human Resource any citation, arrest, conviction for a misdemeanor or felony crime.
• REQUIRED to accept the responsibility of a Mandatory Reporter in accordance with the Klamath Tribes Juvenile Ordinance Title 2, Chapter 15.64 and General Council Resolution #2005 003, all Tribal staff are considered mandatory reporters.
Work Type: Permanent, Full
Who May Apply? All Groups of Qualified Individuals
Get Details & Apply:
https://recruiting.paylocity.com/recruiting/jobs/All/453c706f-6d46-4ecd-b66b-8fce6fffc60e/Klamath-Tr Exit Disclaimer: You Are Leaving www.ihs.gov