Careers

Careers in the Northwest

Nurse Case Manager - Team Lead — Pacific Source

Posted February 5, 2018

Nurse Case Manager – Team Lead

Position Overview: Accountable for the effective management of the Nurse Case Managers for the Commercial LOB. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. May be called upon to perform routine day-to-day program functions. Actively participate in program development and implementation. Supervise and provide guidance to direct reports and other department staff regarding company policies, procedures, and operations. Manage the quality and productivity of team tasks and workflow as they relate to both assigned functions and the overall effectiveness of the Health Services team. Work to resolve issues and improve processes and outcomes.

Essential Responsibilities:

1. Take a leadership role in the development, implementation, and ongoing operation and maintenance of assigned programs, services, or functions.

2. Improve the performance of the department through effective oversight and coaching of team members, managing team performance and improving processes and outcomes. Monitor daily workflow and caseloads and other work processes of team to assure appropriate distribution and processing of tasks.

3. Responsible for the orientation and training of new hires.

4. Provide ongoing supervision, training, evaluation, and leadership to assigned team members. This may include annual reviews, involvement in promotions and/or terminations of employees.

5. Participate in hiring decisions in concert with Medical Services Director and/or Medical Services Manager and HR.

6. Monitor and evaluate team assignments relating to volumes, timelines, accuracy, customer service, and other quality and performance measures, and take actions as appropriate.

7. Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards to monitor key performance indicators and identify improvement opportunities.

8. Serve as liaison with other PacificSource departments or community partners to coordinate optimal provision of service and information. Serve on various internal and external committees as required or designated. Document and report any pertinent communications back to the team or department.

9. Utilize and promote use of evidence-based medical criteria.

10. Maintain modified caseload consistent with assigned responsibilities.

11. Facilitate investigation and resolution of process-related issues as needed. Facilitate conflict resolution, including interfacing with affected departments and individuals, as appropriate.

12. Oversee and assist in providing exceptional service and information to members, providers, employers, agents, and other external and internal customers.

13. Provide backup to other departmental teams or management staff, as needed.

Supporting Responsibilities:

1. Meet department and company performance and attendance expectations.

2. Relate new or revised policies, procedures and/or processes to team members to ensure they have the most up‐to‐date and current information.

3. Facilitate team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem‐solving recommendations, and recommendations of standardizing Health Services operations.

4. Represent the Heath Services Department, both internally and externally, as requested by Health Services Manager and/or Director.

5. Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: A minimum of five years clinical experience, including case management experience required. Minimum of three years direct health plan experience in the following areas: case management, utilization management, behavioral health, and/or disease/condition management strongly preferred. Prior supervisory experience preferred.

Education, Certificates, Licenses: Registered Nurse or Licensed Clinical Social Worker with current appropriate unrestricted state license. Certified Case Manager Certification, or equivalent, strongly desired or willingness to obtain certification within 2 years of hire.

Knowledge: Knowledge of health insurance and state mandated benefits. Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes, including ICD-10, CPT Codes, health insurance and State of Oregon mandated benefits. Effective adult education/teaching and/or group leadership skills. Ability to deal effectively with people who have various health issues and concerns. Strong analytical and organizational skills with experience in using information systems and computer applications. Is flexible. Ability to develop, review, and evaluate utilization and case management reports. Strong computer skills including experience with Word, Excel, and PowerPoint. Ability to use audio-visual equipment. Ability to work independently with minimal supervision.

Competencies

Our Values

· Building Trust

· Building a Successful Team

· Aligning Performance for Success

Building Customer Loyalty
· Building Strategic Work Relationships

· Continuous Improvement

Decision Making
· Facilitating Change

· Leveraging Diversity

· Driving for Results

We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customers’ experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internal and external.
We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Nurse Case Manager - Utilization Management — Pacific Source

Posted February 5, 2018

Nurse Case Manager – Utilization Management

Position Overview: Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services. Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available. Ensure proper utilization of services and resources. Provide assistance within, between, and outside of facilities. Facilitate outstanding member care using fiscally responsible strategies.

Essential Responsibilities:

1. Collect and assess member information pertinent to member’s history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services.

2. Coordinate necessary resources to achieve goals and objectives. Accurately document case notes and letters of explanation which may become part of legal records.

3. Perform concurrent review of members admitted to hospitals. Maintain telephone contact with the hospital utilization review personnel to assure appropriateness of continued stay and level of care. Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, home health or hospice services.

4. Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets.

5. Identify and negotiate with appropriate vendors to provide services. When appropriate, negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development.

6. Serve as primary resource to member and family members for questions and concerns related to the health plan and in navigating through the health systems issues.

7. Interact with other PacificSource personnel to assure quality customer service is provided. Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies. Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients.

8. Identifies high cost utilization and makes appropriate referral to case management team.

9. Assist Medical Director in developing guidelines and procedures for Health Services Department.

Supporting Responsibilities:

1. Act as backup for other Health Services Department staff and functions as needed.

2. Serve on designated committees, teams, and task groups, as directed.

3. Represent the Heath Services Department, both internally and externally, as requested by Medical Director.

4. Meet department and company performance and attendance expectations.

5. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

6. Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Five years of nursing experience with varied medical exposure and experience preferred. Experience in acute care, case management, including cases that require rehabilitation, home health, and hospice treatment strongly preferred. Insurance industry experience helpful, but not required.

Education, Certificates, Licenses: Registered Nurse with current unrestricted state license. [Oregon license required at time of hire; Montana and Idaho required within 6 months of hire.) Certified Case Manager (CCM) as accredited by CCMC (The Commission for Case Management Certification) preferred.

Knowledge: Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedures codes including ICD 10 and CPT Codes, health insurance and state-mandated benefits. Understanding of contractual benefits and options available outside contractual benefits. Working knowledge of community services, providers, vendors and facilities available to assist members. Understanding of, and ability to create appropriate case management plans. Ability to use computerized systems for data recording and retrieval. Assures patient confidentiality, privacy, and health records security. Establishes and maintains relationships with community services and providers. Maintains current clinical knowledge base and certification. Ability to work independently with minimal supervision. Must be able to function as part of a collaborative, cohesive team.

Competencies

Our Values

Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards

We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customers’ experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our communities-internal and external.
We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Medical Case Consultant (RN) — Immigrant and Refugee Consultant Community Organization (IRCO)

Posted November 2, 2017

Wage: $66,000 – $70,000 per year with Benefits

Location: DHS East County Family Service Center

Apply At: www.irco.org  

Status: 32 Hours per week- Full Time/Non-Exempt

Schedule: 8:30am – 5:00pm, 4 days per week

Program(s): Community Works Project (CWP)

Opening Date: July 27, 2017

Closing Date: Open until filled

Language: English Fluency Required

Driving: Not Required

Click for more information about this job opening….

 

 

 

Return to Work Consultant — SDAO

Posted September 28, 2017

Position Definition

 

Return-to-Work Consultant:

Responsible for implementing SDIS’s return-to-work programs by coordinating between member districts, SDAO’s claims staff and medical providers to facilitate the injured worker’s return to suitable employment following a workplace injury.  Actively promote return-to-work programs as a strategy for reducing claim costs and assisting member districts in designing and implementing return-to-work programs.

 

Specific Duties

 

Under the direct supervision of the Risk Manager, this position is responsible for the following duties:

 

 

 

 

 

 

 

 

Required Knowledge, Skills and Abilities

 

 

Training and Experience Requirements:

 

Physical Requirements

 

 

FLSA Status

 

Position duties will follow all applicable state and federal employment laws including ADA and workplace harassment.

Contact Information:

Gina Wescott
Workers’ Compensation Claim Manager*
gwescott@sdao.com

S | D | A | O       Administrators for SDIS

RN Case Manager — Moda Health

Posted September 20, 2017

Apply today at: https://ejob.bz/ATS/PortalViewRequirement.do?reqGK=27038151

Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda Health is seeking a Case Manger RN to perform case management within the boundaries of accreditation organization standards to ensure appropriate care is delivered timely and within the appropriate setting for Moda members; interacts with the member, family and care providers to develop, coordinate and monitor the member’s treatment plan.

Primary Functions:
•    Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring and evaluation.
•    Assessment: collection of in-depth information about a member’s situation and functioning to identify individual needs.
•    Planning: identification of specific objectives, goals, and actions designed to meet the member’s needs as identified in the assessment.
•    Implementation: execution of the specific case management activities that will lead to accomplishing the goals set forth in the plan.
•    Coordination: organization, securing, integrating and modifying resources.
•    Monitoring: gathering sufficient information to determine the plan’s effectiveness and the evaluation phase should determine the effectiveness of reaching the desired outcomes.  Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care.  Utilizes evidence-based criteria that incorporates current and validated clinical research findings.  Practices within the scope of their license.
•    Consults with physician advisers to ensure clinically appropriate determinations.
•    Serves as a resource to internal and external customers.
•    Applies clinical expertise and judgment to ensure compliance with medical policy and criteria of for accepted standards of care while performing Utilization Review and Service Authorizations for members of all books of business.
•    Collaborates with other departments to resolve claims, quality of care, member or provider issues.
•    Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.
•    Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.
•    Provides consistent, accurate and timely documentation.
•    Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines
•    Other duties and responsibilities as assigned

Working Condition:
– Work is performed in office setting at Moda Tower in Downtown Portland, Oregon
– Work week is Monday through Friday
– Work in excess of standard work week to meet business needs may occur
– Prolonged amount of sitting and working on PC with extensive keyboard and telephonic work daily
– Occasional travel for meeting outside of the office
– Ergonomic Assessment is provided for each employee upon hire and as needed ensuring work station is ergonomically correct and user-friendly

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

Required Skills

  1. Graduate of accredited school of nursing; two, three or four-year program.
    2. Requires current unrestricted Oregon Nursing license as a registered nurse or current Mental Health license or equivalent in Social Service.
    3. Certification in case management or utilization review/management required or ability to obtain within 24 months of hire.
    4. Must have 3 years recent hospital, home health or acute care experience.
    5. Proficient with Microsoft Office applications and type a minimum of 35 wpm on a computer keyboard.
    6. Strong analytical, problem solving, memory retention, organizational and detail orientation skills.
    7. Exceptional verbal and interpersonal communication skills including management of the angry customer.
    8. Ability to work well under pressure.
    9. Project a professional business image telephonically and in person.
    10. Ability to come in to work on time and on daily basis.

 

Apply today at: https://ejob.bz/ATS/PortalViewRequirement.do?reqGK=27038151

Manager Care Management — Moda

Posted September 17, 2017

Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda Health is seeking a Manager in our Healthcare Services department for Care Management. This position provides operational leadership for the care coordination, clinical disease management and case management functions; serves as a clinical advisor for staff to ensure the clinical quality and efficacy of member-facing efforts; develops and implements plans required to meet the care needs of Plan members.

Primary Functions:
01. Oversees the non-UM-related care coordination, clinical disease management and case management functions
02. Develops and oversees the implementation of strategies to improve plan performance in terms of utilization, patient access, cost, compliance with contractual quality measures, etc.
03. Participates in clinical strategy development and implementation.  Collaborates with both internal and external stakeholders to develop and implement strategic clinical and administrative goals.
04. Identifies financial, access and utilization data needs as indicated and coordinates analyses to improve care outcomes
05. Promotes quality outcomes and measurement of those outcomes.  Prepares routine and ad hoc reports regarding issues related to Care Management practice.
06. Recommends and implements action plans to improve clinical service delivery, educate providers, resolve quality improvement issues, and ensure accuracy of data used by CMS
or similar organizations.
07. Align improvement activities with quality and financial goals.
08. Establishes and implements departmental policies, goals, objectives and procedures
09. Demonstrates responsible management of all departmental resources. Continuously assesses measures and improves departmental performance. Ensures that the professional development needs of staff are met.
10. Performs other duties as assigned.

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

Required Skills
• Bachelor’s of Science in Nursing or closely related field
• Five (5) years of experience in health care service delivery
• Three (3) years of experience in Utilization Management, Care Coordination and/or Case Management – preferably with a health care insurance plan
• Experience with the application of standards of care, criteria and guidelines
• Experience managing people and projects
• Demonstrated success driving change in the healthcare delivery system, from either a provider or plan perspective.
• Strong project management, clinical data and financial analysis skills.Required Certificates, Licenses and Registrations:
• Registered Nursing degree or other health professional degree.
• Active, unrestricted State of Oregon license.

If interested or for more information please contact:
Margerie Reyes at  margerie.reyes@modahealth.com

Nurse Manager, Utilization Management — Legacy Health

Posted August 17, 2017

Legacy Health

Nurse Manager, Utilization Management                    

Portland, Oregon

 

Does your passion for patient care and excellence match ours? Create your legacy: join our team!

 

Relocation assistance available!

 

We have an exciting new nursing opportunity for a full-time Nurse Manager to join our Care Management team.

Collaborating with seven peer Care Management Managers and reporting to the Care Management Director, the Nurse Manager in this role will manage the day-to-day operations and provide clinical and administrative leadership to the 21 Utilization Management RN team members, as well as focus on bringing the electronic health records review process internally.

 

Qualifications:

 

 

Located in the beautiful Pacific Northwest, named by Forbes, a national business magazine, to its 2016 list of best midsize employers in the US, Legacy Health, with more than 13,000 employees, is a regional integrated health system that consists of seven hospitals, including Legacy Emanuel – a level I trauma center, Randall’s Children’s Hospital, dozens of primary care and specialty clinics, a regional medical laboratory service and the brand-new Unity Center for Behavioral Health.

 

We strive to be a diverse, culturally responsive organization, and encourage individuals with diverse backgrounds and those who promote diversity and inclusion to apply. AA/EOE/VETS/Disabled

Visit our website at www.legacyhealth.org/careers to apply to position # 17-2462. Questions: contact Veronique Lhote at (503) 415-5585 or email vlhote@lhs.org.

Full time and Part time Case Managers Needed! — Salem Health

Posted July 18, 2017

Salem Health is seeking several talented RN Care Managers to join our team!

Description: 

Under the general supervision of the RN Supervisor, RN Care Managers provide clinically-based care management to support the delivery of effective and efficient patient care. Responsible for the overall accountability for care coordination, utilization management and discharge planning for patients within the assigned caseload. Collaborates with other members of the health care team to identify appropriate utilization of resources and to support appropriate and compliant reimbursement. Utilizes criteria to confirm medical necessity for admission and continue stay. With the patient, family, and health care team, creates a discharge plan appropriate to the patient’s needs and resources.

Minimum Qualifications Include:

• Requires BSN or non-nursing Bachelor’s Degree with MSN for all external applicants for Salem Hospital, preferred for West Valley Hospital. Bachelor of Arts in Nursing also accepted.
• For internal applicants preference may be given to applicant with BSN.
• Minimum of one (1) year of Clinical Nurse experience required.
• Current unencumbered licensure to practice nursing as a Registered Nurse in the State of Oregon required.
• BLS issued by the American Heart Association required.

Apply today at www.salemhealth.org

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