RN Case Manager

Moda Health•Portland, OR

1d•Remote

About The Position

The RN Case Manager performs 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. This is a FT WFH position. The salary range for this position is $77,364.14 - $96,705.18, DOE. This role may be classified as hourly (non-exempt) depending on the applicant's location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range. Please fill out an application on our company page, linked below, to be considered for this position. https://j.brt.mv/jb.do?reqGK=27768976&refresh=true

Requirements

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

Responsibilities

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 advisors 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
Perform other duties and responsibilities as assigned.