Providence Health & Services Registered Nurse - Case/Disease Management Care Coordinator in Spokane, Washington
Providence St. Joseph Health is calling a Registered Nurse - Case/Disease Management Care Coordinator to our location in Beaverton, OR.
We are seeking a Registered Nurse Care Coordinator Case and Disease Management to provide care coordination services to Providence Health Plans(PHP) members. Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease. Case management including: triage and referral, transition of care planning, end of life care planning, other acute and catastrophic case management. These services are offered to members and their families who have acute and complex health care needs; members with chronic conditions at risk for poor health outcomes and members who are terminal and nearing end of life. Care management services include nurse education, care coordination and general assistance with managing day to day functional needs; assisting with the management of member health plan benefits and offering assistance finding alternative services when benefits are exhausted. This position works within the health plan framework of managing medical expenses while also working to improve access and quality care to our members.
Reporting on productivity and service standards to demonstrate effectiveness and efficiency of programs.
Functioning as a liaison and problem solver with multiple departments and providers.
Defusing conflicts and negotiating solutions in potentially volatile situations.
Managing multiple priorities efficiently and effectively.
Integrating and using health information data and literature from various sources.
Maintaining quality program standards while meeting productivity targets.
Patient Population Served: Neonate, Pediatric, Adolescent, Adult, Geriatric
Consequently, the employee must be competent in the interpretation of a patient's self-report or behavior, and this information must be interpreted with an understanding of the cognitive, physical, emotional/psychosocial and chronological maturation process. The treatment of patients should be individualized and should reflect an understanding of the developmental needs and range of treatment needs for each patient.
In this position, you will:
The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position.
The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position. The degree of fluency required will vary depending upon the nature of the position.
Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and standards of their organization.
For direct patient care roles: Performs and maintains currency of essential competencies as required by specific area of hire and populations served.
• Participate in discharge planning, care coordination and post hospital follow up calls for hospitalized members, following department policies and procedures.
• Maintain professional working relationships with health care providers and facilities, case managers, community liaison staff and members and families when providing care coordination services and health education.
• Perform the six essential activities of case management: assessment, coordination, planning, monitoring, implementation and evaluation, in multiple environments.
• Perform case management duties to effectively manage services, benefits, costs and quality, following policies and procedures as outlined.
• Provide disease management programs and services following policies and procedures as outlined.
• Track and report case management activities, savings and outcomes as outlined in the policies and procedures.
• Screen members through a Health Risk Assessment (HRA) for case and disease management programs and services.
• Review high cost reports and member utilization experience and prepare clinical reports outlining the member diagnosis, prognosis and treatment, following established procedures.
• Participate in program development, clinical supervision and continuing education.
• Exceptional Needs Care Coordinator (Specialized services provided to Oregon Health Plan members who are Aged, Blind or Disabled) duties include:
• Early identification of those Aged, Blind, Disabled DMAP members that have disabilities or complex medical care needs.
• Assist members to ensure timely access to providers and services.
• Assist providers with coordination of services and discharge planning to meet the unique needs of disabled members.
• Assist with coordinating community support and social service systems linkage with medical care systems, as necessary and appropriate.
• Act as an internal resource regarding knowledge of Oregon Health Plan to the Providence Health System.
• Participate and represent Providence Health Plans at state, county, and community agency meetings throughout the service areas.
• Assist in the development of department polices and procedures.
• Identify quality of care issues for review, as outlined in department procedures.
• Provide training and expertise, when asked, on medically related issues.
• Maintain a thorough knowledge of managed care and other health plan departments including: QMM medical management programs, regulatory standards related to care coordination and quality, provider network and credentialing, medical review and claims audit programs.
• Identify internal and external customers; determine customer needs and meet those needs.
• Represent the organization in a professional manner, supporting the programs, goals and objectives; support the mission and be a role model for others, as a team member and a professional. Maintain personal and professional development.
• Assure confidentiality is maintained regarding health information, health status, medical records, claims and employee records, per the confidentiality policies and procedures.
Required qualifications for this position include:
• Atleast 5 years of clinical nursing experience.
• Experience working with physicians in the collaboration and management of patient care.
• Must have a current license as a registered nurse (RN) in the state of Oregon.
• Additional RN license in the state of Washington preferred.
• Must hold a valid drivers license.
Preferred qualifications for this position include:
• Bachelor's Degree in Nursing or health education.
• Current nursing experience in the following areas: cardiology, endocrinology, pediatrics, obstetrics, oncology, respiratory, health education.
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Health Plan/Insurance Nursing
Req ID: 240329