RN Director, Nursing Case Management

CareOregon•Portland, OR

1d•$155,430 - $189,970•Hybrid

About The Position

The Director, Nursing Case Management leads the execution of clinical and non-clinical nursing care coordination strategy and activities across the organization. The role focuses primarily on business-group oversight, with additional enterprise-wide engagement, and is responsible for operational planning and oversight, resource management, relationship management, and people leadership. The Director contributes to broader organizational strategic plans and provides leadership to the Medicare nursing team. This is a hybrid position requiring two days per week in the office, Tuesday and Thursday. Priority will be given to candidates residing in Oregon and Southwest Washington. The estimated hiring range is $155,430–$189,970, with a 10% annual SIP bonus target. The Director oversees care coordination teams and services, ensuring regulatory compliance, sound clinical practice, quality improvement, and effective coordination with internal and external partners. The role develops departmental strategy and annual goals, contributes to budgeting and resource decisions, represents CareOregon externally, and recruits, leads, coaches, and develops employees. Work is primarily in an indoor office environment and includes telephonic member/patient contact. Occasional travel may be required. General office equipment is used.

Requirements

At least 8 years of related experience, including clinical care, health care coordination, and/or health care operations.
Bachelor of Science in Nursing degree.
Current unencumbered RN license in the State of Oregon.
Strong knowledge of case management and care coordination needs for diverse populations.
Strong knowledge of federal, state, and local regulations and HIPAA privacy rules and regulations.
Proficient knowledge of the Epic system.
Superior care management, team management, organizational, and problem-solving skills.
Effective strategic planning, policy development, and process improvement skills.
Excellent time-management, organizational, and communication skills.
Advanced computer skills and working knowledge of MS Office, Outlook, and the internet.
Ability to lead data collection, analysis, and management effectively.
Ability to work with high energy; be persistent, assertive, data-driven, and focused; and drive performance and difficult tasks to completion.
Open leadership style and ability to support collaborative thinking and problem-solving within and outside the organization.
Proficiency in developing KPI metrics reporting for clinical operations.
Ability to influence without direct authority and negotiate favorable outcomes.
Ability to communicate complex ideas and processes clearly and concisely.
Ability to balance strategic and operational priorities and proactively identify and resolve operational barriers and issues.
Ability to direct teams of clinical and non-clinical operations support staff engaged in diverse activities.
Team-management skills, including hiring, goal setting, coaching, performance management, and employee development.
Ability to establish strategic partnerships with multiple internal and external stakeholders.
Ability to work with internal and external stakeholders on technology, process, and regulatory issues.
Ability to work effectively with diverse individuals and groups.
Ability to learn, focus, understand, and evaluate information and determine appropriate actions.
Ability to accept direction and feedback and tolerate and manage stress.
Ability to see, read, hear, and speak clearly, and perform repetitive finger and wrist movements for at least six hours per day.

Nice To Haves

At least 4 years of supervisory experience.
At least 5 years of experience in managed care or the health insurance industry.
Master of Science in Nursing degree.
RN Case Management Certification.

Responsibilities

Provide operational leadership and oversight to care coordination teams, including nursing care managers, supervisors, leads, and front-line staff.
Plan and oversee care coordination services in compliance with local, state, and federal regulations.
Consult with and oversee nursing care managers on complex case management and disease management issues.
Consult with the Vice President of Care Coordination, Medicare Medical Director, and Model of Care Director on medical issues and administrative responsibilities, including QAPI, Model of Care, and compliance.
Help define the strategic approach to case management, disease management, and population health interventions in consultation with Medicare leadership.
Safeguard the ICT collaboration process, provide leadership, and facilitate problem-solving.
Ensure systems maintain accurate, complete, and compliant medical records, including adherence to HIPAA and applicable standards.
Develop or approve procedures and oversee their development and dissemination.
Support QAPI and Model of Care activities by reviewing patient services and outcomes data, presenting and submitting team data, and setting and monitoring targets for performance improvement, productivity, quality, and documentation.
Provide clinical leadership in developing and reviewing protocols and processes that support appropriate referrals and consistent-quality care coordination.
Provide clinical and quality consultation to managers and team members.
Plan and implement staff education programs and guide and document staff participation.
Improve team capabilities through care coordination improvements with partner organizations, clinician development, resolution of process bottlenecks, creation of tools and processes, and compliance oversight.
Lead development and implementation of departmental vision, goals, and strategic plans, and provide input into organizational strategic plans.
Develop annual program goals aligned with organizational strategy in collaboration with the Vice President of Care Coordination and Medicare Medical Director.
Develop short- and long-term plans and policies and oversee standard operating procedures.
Set department priorities while considering broader business-unit and organizational impacts.
Participate in annual department budgeting, recommend budgets aligned with plans, manage resources, recommend resource-use and cost-containment changes, secure approvals for budget variances, and approve in-budget resource allocations and exceptions.
Lead effective communication and a collaborative culture within work groups; build relationships across internal teams and external organizations.
Partner with internal leaders and managers to identify improvement plans and processes, and represent CareOregon in external meetings and functions.
Direct teams and establish team direction and goals aligned with organizational mission, vision, and values.
Identify staffing models, recruit and hire employees, and oversee teams using an equity, diversity, and inclusion lens.
Set department priorities and ensure employees have the information and resources needed to meet expectations.
Develop, communicate, and oversee team and individual goals, expectations, and standards.
Manage, coach, motivate, guide, and develop employees.
Apply CareOregon equity tools to people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision-making.
Ensure teams adhere to departmental and organizational standards, policies, and procedures.
Evaluate employee performance, provide regular feedback, recognize strong performance, address performance gaps, and take corrective action as appropriate.
Perform supervisory tasks in collaboration with Human Resources as needed.

Benefits

Medical insurance
Dental insurance
Vision insurance
Life insurance
AD&D insurance
Disability insurance
Health savings account
Flexible spending account(s)
Lifestyle spending account
Employee assistance program
Wellness program
Employee discounts
Supplemental benefits, including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings
Retirement plan with employer contributions
PTO
Paid State Sick Time
Paid holidays
Paid volunteer time
Jury duty leave
Bereavement leave
401(k) contributions