Rn Case Manager Jobs

Description

The Case Manager/Care Coordinator will work to assist clinicians, members and community clinicians in the coordination of medical services between the health plan, and community providers and facilities. Includes interfacing with clinicians, community providers and members to ensure the member receives high quality, safe, efficient and timely medical services.

Job Duties

Includes interfacing with clinicians, community providers and members to ensure the member receives high quality, safe, efficient and timely medical services

Preview and preapprove requests for referral to community clinicians and/or programs for medically necessary services as requested by the clinician.

Work directly with the member and the community clinician to coordinate medical services within KPNW, providing accurate and timely information to the community physician and member related to requested services.

Maintain knowledge base of resources available within the community and Kaiser Permanente assists with arranging for medical services in the appropriate location.

With Community Medicine Integration Center leadership, insures compliance with regulatory and accrediting requirements for utilization of referred services, including NCQA, MDQR, Federal and State agencies.

Maintains knowledge of policies, procedures and benefits

SCHEDULE: Monday - Friday, 8:00 AM - 5:00 PM (40 hours/week)

• Note: Some weekend shifts may be required.

Must Haves

Additional Skills & Qualifications:

Current Oregon and Washington RN license

Basic Life Support certification (BLS) - MUST be through the American Heart Association!

High School Diploma or GED

Valid Driver's License

EMR/EHR experience

Minimum two (2) years of experience in case management, care coordination, or population care.

Minimum two (2) years of direct patient care as a registered nurse.

Knowledge of case management principles.

Knowledge of Oregon Health Plan, including ORS requirements, pharmacy rules and regulations and OHP list of treatable diseases.

Knowledge of community resources for the care of the elderly and disabled.

Demonstrates customer-focused service skills.

Demonstrated ability to organize, coordinate, and manage care plans. Thorough knowledge of levels of care within outpatient, acute

care, and extended care settings.

Demonstrated ability to work as part of a multidisciplinary team.

Excellent written and verbal communication skills.

Ability to present reports verbally in a public setting (public speaking).

Demonstrated data entry skills and ability to use Microsoft Word software.

Ability to work independently and efficiently under pressure

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