RN Case Manager
RN Case Manager
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.
Position Summary
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 members treatment plan. This is a FT WFHposition.
The salary range for this position is $39.67 $49.59 DOE.
*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.
Dental Vision Pharmacy Life & Disability
Primary Functions:
- Responsible for essential activities of case management including assessment planning implementation coordination monitoring and evaluation.
- Assessment: collection of indepth information about a members situation and functioning to identify individual needs.
- Planning: identification of specific objectives goals and actions designed to meet the members 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 plans 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 evidencebased 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.
Required Skills Experience & Education:
- Graduate of accredited school of nursing; two three or fouryear 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.
Contact with Others & Working Conditions:
Office environment with extensive close PC and keyboard work constant sitting and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week including evenings and occasional weekends to meet business need.
Internally with all departments and levels of staff. Externally with community organizations state agencies providers and office staff healthcare associations and representatives and members.
Together we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.
For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our email.
Required Experience:
Manager
Employment Type
Full-Time
