SUMMARY
This position is responsible for providing ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs. This position is also responsible for promoting continuity of care and cost effectiveness through the integrating and functions of case management, utilization review, and discharge planning by performing the following duties.
- Identifies and develops Care Plans for assigned members.
- Monitors utilization review to determine eligibility, appropriate level of care, quality of care, continuity of care, and cost effectiveness of services provided to the member.
- Coordinates with local agencies, Primary Care Physicians (PCP), and community resources to identify members in need of Case Management (CM) services by reviewing health risk assessment and other pertinent reports to identify members in need of CM services.
- Regularly attends the Interdisciplinary Care Team (ICT) meetings, care coordination meetings, and other meetings as assigned.
- Manages the care, coordination, and discharge planning of all assigned members.
- Develops a working relationship with the member, family, and care team and serves as an advocate.
- Develops a Care Plan through assessments of member's needs, condition, environment and medical records.
- Reviews cases with Manager or Director and the Chief Medical Officer when necessary.
- Ensures all Care Plan's include the assessment, interventions, measurable short and long term goals, and outcomes.
- Provides education for both the member and their family or support system.
- Manages and maintains incentive programs as applicable to assigned populations.
- Coordinates with the members Primary Care Physician (PCP), specialist, and other community resources involved in care of the member.
- Maintains a positive working relationship with other agencies and providers including out of area.
- Improves processes by continually developing new systems.
- Accumulates data and process reports accurately and timely.
- Maintains confidentiality and complies with HIPAA rules and regulations.
- Maintains punctual, regular and predictable attendance.
- Works collaboratively in a team environment with a spirit of cooperation.
- Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
- Respectfully takes direction from manager.
EDUCATION and/or EXPERIENCE
Associate's degree or equivalent in Nursing from two-year college or technical school and a minimum of two years related experience and/or training
COMPUTER SKILLS
Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.
CERTIFICATES, LICENSES, REGISTRATIONS
This position requires an Oregon Nursing license. Case Management certification (CCMC) or other relevant nationally recognized certification is required within two years of date of hire.
We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.