Clinical Program Coordinator RN, Maternity / Pediatrics *Remote*

About the position

The Clinical Program Coordinator RN, Maternity / Pediatrics at Providence Health Plan is responsible for providing care coordination and case management services for members, focusing on areas such as maternity, pediatrics, and other specialized medical needs. This role emphasizes improving access and quality of care while managing medical expenses within the health plan framework. The position is fully remote for candidates residing in Oregon or Washington, and it operates on a Monday to Friday schedule from 8 am to 5 pm.

Responsibilities

• Support the commercial insurance based line of business for cases including Maternity, Pediatrics, Transplant, and Pain Management.
• Provide care coordination, case management, and care management services to Providence Health Plans (PHP) members.
• Conduct triage and referral, transition of care planning, and acute and catastrophic case management.
• Assist with nurse education, care coordination, and managing day-to-day functional needs of members.
• Help manage member health plan benefits and find alternative services when benefits are exhausted.
• Work to improve access and quality care for members.

Requirements

• 5+ years of clinical nursing experience.
• Experience working with physicians in the collaboration and management of patient care.
• Current unencumbered Registered Nurse License in state of residency.

Nice-to-haves

• Bachelor's Degree in Nursing or Health Education.
• Current unencumbered Registered Nurse License in Oregon upon hire.
• Current unencumbered Registered Nurse License in Washington State within six months of hire date.
• Case Management Experience (e.g., Triage and Referral, Transition of Care Planning, Discharge Planning).
• Utilization Management Experience (e.g., Concurrent Review, Prior Authorization, Medical Audits).
• Experience working in a health plan or medical insurance plan.
• Current nursing experience in chronic pain management, cardiology, pediatrics, or maternity.

Benefits

• 401(k) Savings Plan with employer matching
• Health care benefits (medical, dental, vision)
• Life insurance
• Disability insurance
• Paid parental leave
• Vacation and holiday time off
• Voluntary benefits
• Well-being resources