DescriptionPosition SummaryThis is a FT hybrid position based in Portland, Oregon. Leads and supervises RN Care Coordination team. Oversees commercial and individual plan medical utilization management program by managing workflow, training staff, auditing quality, and reporting cost savings, productivity, and other performance measures.
Pay Range$86,486.08 - $110,265.00 annually (depending on experience) *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.Benefits:- Medical, Dental, Vision, Pharmacy, Life, & Disability
- 401K- Matching
- FSA
- Employee Assistance Program
- PTO and Company Paid Holidays
Required Skills, Experience & Education:- Requires current unrestricted Oregon RN license, and degree from accredited school of nursing
- Supervisory, management or lead experience in a medical and/or health insurance setting is required.
- Minimum 3 years of Utilization Management, Care Coordination or Case Management experience with health plan or similar organization.
- Analytical and detail oriented, with demonstrated initiative, problem solving, organizational, and critical thinking skills.
- Proficiency with Microsoft Word and Excel is required, with typing speed of 35 wpm or better.
- Excellent verbal, written and interpersonal communication skills. Demonstrated skill in speaking and presenting to groups.
- Ability to work well under pressure.
- Ability to maintain confidentiality and project a professional business image.
- Ability to come in to work on time and daily.
Primary Functions:- Ensures department standards and goals are achieved through training, delegating, and coaching of staff. Develops, maintains, and reports performance measures for work team. Monitors through training and auditing to assure compliance with NCQA and CMS standards.
- Supervises clinical staff providing daily work direction, vacation scheduling, monitoring attendance, giving performance reviews, hiring, and training new employees.
- Determines and implements an organized and systematic management plan for handling such cases.
- Develops programs with acute care coordination component. Understands the care coordination environment and facilitates integrating chronic disease programs into day-to-day workflow.
- Assists Manager with development and implementation of utilization management and care coordination programs
- Participates in internal and external audits
- Ensures comprehensive communication and integration with all medical management and case management programs and functions.
- Monitors and reports on program outcomes, value, performance, and quality, ensuring accuracy and timeliness.
- Establishes contacts with health care vendors and coordinates with providers when necessary to achieve case management and care coordination objectives.
- Establishes effective, collaborative working relationships with peers within department and with all other departments.
- Develops and implements staff development & education curricula. Facilitates and coordinates weekly team meetings.
- Performs other duties as assigned.
Working Conditions & Contact with Others- Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
- Internally with all departments. Externally with providers, provider offices, members, and groups.
