Clinical Care Manager RN I

Samaritan Health Services

Corvallis (OR)

Hybrid

USD 85,000 - 105,000

Full time

2 days ago

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Job summary

Samaritan Health Services in Oregon is seeking a Registered Nurse to support care coordination and case management across our clinics. This hybrid role requires onsite patient interaction and collaboration with care teams.

You will assess, plan, implement, coordinate, monitor and evaluate options to meet patients' health needs, with emphasis on transitions of care and Medicare/Medicaid guidelines.

Qualifications

Current unencumbered Oregon RN License required.
One year clinical nursing experience required.
Experience or training in health care delivery systems and/or managed care; computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
Experience in case management; Medicare/Medicaid rules and health plan benefit structure and policy.

Responsibilities

Assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs.
Provide care management interventions and seamless support across transitions of care.
Work with cases that have a low to moderate level of service intensity.

Skills

Communication

Confidentiality

Critical thinking

Social perceptiveness

Medicare/Medicaid rules

Education

RN License (Oregon)

BSN preferred

Tools

MS Office

EPIC

Clinical Care Advanced

Job description

Summary

Hybrid position that will require onsite presence at our clinics to work with patients.

Occasionally

JOB SUMMARY/PURPOSE
- Assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs. Applies knowledge of applicable regulations, identifies resources (internal or community partners) and eliminates barriers where possible. Provides care management interventions and seamless support across transitions of care. Works with cases that have a low to moderate level of service intensity.

DEPARTMENT DESCRIPTION

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

EXPERIENCE / EDUCATION / QUALIFICATIONS

Current unencumbered Oregon RN License required. BSN preferred.
One (1) year clinical nursing experience required.
Experience or training in the following required:
- Health care delivery systems and/or managed care patients.
- Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
Experience in the following preferred:
- Case management.
- Medicare and Medicaid rules and regulations and health plan benefit structure and policy.

KNOWLEDGE / SKILLS / ABILITIES

Communication - Effective written and verbal communication skills provided to members, providers and organization staff. Able to tactfully discuss issues, and listen to and understand complex information/situations. Ability to apply motivational interview techniques when working with members. Proactively resolve conflicts in positive and constructive manner.
Confidentiality - Knowledge of State and Federal (HIPAA) laws pertaining to confidentiality of protected health information. Ability to comply with laws and maintain confidentiality of patient information.
Critical Thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions in a member centric manner.
Social Perceptiveness - Ability to work with a diverse population from pediatrics to geriatrics. Basic understanding of age-related differences in caring for and/or communicating with members and caregivers. Possess personal sensitivity to the needs and experiences of others and a non-judgmental attitude towards persons of differing standards, values, lifestyles, and ages.
Knowledge of Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Ability to appropriately apply evidence based clinical practice and criteria to authorization requests.

PHYSICAL DEMANDS

Rarely (1 - 10% of the time)

Sometimes (11 - 33% of the time)

Frequently (34 - 66% of the time)

Continually (67 - 100% of the time)