Job Summary
The Case Manager will contribute to enhancing the company's success through personalized care planning, ensuring optimal outcomes and compliance with payer standards. Their collaboration with healthcare team members strengthens the overall effectiveness of care delivery, while their expertise in coordinating diverse beneficiary needs reflects the company's commitment to overall well-being.
This position is remote. However, applicants must reside within the state of Oregon.
Key Responsibilities
- Provide care coordination/care management for beneficiaries, ensuring a high level of clinical knowledge and performance by the clinical team
- Foster a caring philosophy in leadership and all aspects of the care management process
- Manage the care of beneficiaries through the healthcare system based on their individual needs for social, physical, vision, dental, behavioral, pharmacy, and preventative health services
- Use independent judgment and discretion to address and proactively resolve barriers impeding diagnostic, social or treatment progress
- Interact and collaborate with a multidisciplinary care team, including physicians, nurses, case managers, OHA staff, and social workers/educators to ensure as well as participate in IDT meetings beneficiary needs and preferences for health services/information are shared
- Educate beneficiaries about community resources/options and advocate on behalf of the beneficiary
- Complete health and social assessments for the purposes of care planning using motivational interviewing, trauma informed care and equity principles for all engagements
- Establish a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality outcomes
- Maintain operational requirements for caseload management, securing PHI, working from a plan of care, documentation standards, and other program standards
- Maintain strict standards for client confidentiality and client-related information
- Comply with all organizational, state, and federal regulations and policies on confidentiality
- Prepare documentation, status updates, event notifications, and other documentation regarding beneficiaries in accordance with regulatory requirements and company policies and procedures
- Monitor case load to ensure all required documentation, plan of care, and entry of assessment results into a web-based database are completed accurately and promptly
- Pursue ongoing education, certification, and self-development to remain current with case management standards
- Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules
- Other duties as assigned
Required Qualifications/Experience
- Current, active and unrestricted Oregon Registered Nursing (RN) or Licensed Practical Nursing (LPN) license
- Associate's degree or practical nursing diploma or practical nursing certificate program, in accordance with state requirements
- 2+ years in Medicaid-funded case management or care coordination
- Experience working with individuals from diverse backgrounds and marginalized communities
- Have training and experience in addressing health disparities and promoting equitable health outcomes
- Have training on and experience with integrating cultural competencies and are capable of providing culturally appropriate care
- Experience in communicating with individuals who have a primary language other than English and those with limited English proficiency or who use sign language
- Experience in actively engaging underserved communities and individuals in their own health care planning and goals
Preferred Qualifications/Experience
- Certified Case Manager (CCM)
- Bilingual in English/Spanish
- 2+ years clinical experience
- Strong organizational and time management skills, with exceptional attention to detail and the ability to manage competing priorities, adapt to changing demands, and maintain professionalism and dependability under pressure
- Demonstrated initiative, sound judgment, and effective decision-making skills in performing job responsibilities
- Excellent written and verbal communication, interpersonal, and customer service skills, with the ability to build and maintain relationships with internal and external stakeholders and facilitate meetings
- Ability to work independently and collaboratively as part of a team
- Ability to research, identify, and apply appropriate standards of care
- Commitment to continuous learning and staying informed on regulatory changes
Experience in Lieu of Degree
For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.
Pay Range
USD $67,300.00 - USD $93,050.00 /Yr.