Clinical Care Manager RN I
About The Position
Assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual's health needs. Applies knowledge of applicable regulations, identifies resources (internal or community partners) and eliminates barriers where possible. Provides care management interventions and seamless support across transitions of care. Works with cases that have a low to moderate level of service intensity. DEPARTMENT DESCRIPTION Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
Requirements
- Current unencumbered Oregon RN License required.
- One (1) year clinical nursing experience required.
- Experience or training in Health care delivery systems and/or managed care patients required.
- Experience or training in Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced) required.
- Communication - Effective written and verbal communication skills provided to members, providers and organization staff. Able to tactfully discuss issues, and listen to and understand complex information/situations. Ability to apply motivational interview techniques when working with members. Proactively resolve conflicts in positive and constructive manner.
- Confidentiality - Knowledge of State and Federal (HIPAA) laws pertaining to confidentiality of protected health information. Ability to comply with laws and maintain confidentiality of patient information.
- Critical Thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions in a member centric manner.
- Social Perceptiveness - Ability to work with a diverse population from pediatrics to geriatrics. Basic understanding of age-related differences in caring for and/or communicating with members and caregivers. Possess personal sensitivity to the needs and experiences of others and a non-judgmental attitude towards persons of differing standards, values, lifestyles, and ages.
- Knowledge of Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Ability to appropriately apply evidence based clinical practice and criteria to authorization requests.
Nice To Haves
- BSN preferred.
- Experience in Case management preferred.
- Experience in Medicare and Medicaid rules and regulations and health plan benefit structure and policy preferred.
Responsibilities
- Assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual's health needs.
- Applies knowledge of applicable regulations, identifies resources (internal or community partners) and eliminates barriers where possible.
- Provides care management interventions and seamless support across transitions of care.
- Works with cases that have a low to moderate level of service intensity.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
