Clinical Program Coordinator RN, Medicare / Medicaid Remote
About The Position
Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will: + Provide care coordination, case management and care management services to Providence Health Plans(PHP) members + Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease + Case management services include: triage and referral, transition of care planning, end of life care planning, other acute and catastrophic case management These services are offered to members and their families who have acute and complex health care needs; members with chronic conditions at risk for poor health outcomes and members who are terminal and nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing day to day functional needs; assisting with the management of member health plan benefits and offering assistance finding alternative services when benefits are exhausted + Work within the health plan framework of managing medical expenses + Work to improve access and quality care to our members Providence Health Plan welcomes 100% remote work to residents who reside in the following States: + Washington + Oregon
Requirements
- 5+ years 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
- Upon Hire: Current unencumbered Registered Nurse License in Oregon
- Within six months of hire date: Current unencumbered Registered Nurse License in Washington State
- Case Management Experience (EX. Triage and Referral, Transition of Care Planning, Discharge Planning, Coordination of Outpatient Care)
- Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation)
- Experience working in a health plan, medical insurance plan or another similar work environment
- Current nursing experience in the following areas: chronic pain management, cardiology, endocrinology, pediatrics, obstetrics, oncology, respiratory, health education
Responsibilities
- Provide care coordination, case management and care management services to Providence Health Plans(PHP) members
- Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease
- Case management services include: triage and referral, transition of care planning, end of life care planning, other acute and catastrophic case management These services are offered to members and their families who have acute and complex health care needs; members with chronic conditions at risk for poor health outcomes and members who are terminal and nearing end of life
- Care management services include: nurse education, care coordination and general assistance with managing day to day functional needs; assisting with the management of member health plan benefits and offering assistance finding alternative services when benefits are exhausted
- Work within the health plan framework of managing medical expenses
- Work to improve access and quality care to our members
Benefits
- Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
- Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Hospitals
Number of Employees
5,001-10,000 employees
