Clinical Operations & Care Coordination Lead

Cascade Comprehensive Care Inc; Klamath Falls (OR); Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

Vacation benefits

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Job summary

Cascade Comprehensive Care Inc. is seeking an experienced Clinical Operations Manager to oversee medical and dental authorizations and care coordination for Medicaid members in Oregon.

The role ensures timely processing, regulatory compliance, and cost-effective service delivery across care settings. The position requires an RN license, a CCM certification within 18 months, and a Bachelor’s degree with 3–5 years of related experience.

Qualifications

• Bachelor's degree in a related field.
• 3–5 years related experience and/or training; or equivalent combination of education and experience.
• A valid Oregon Registered Nursing (RN) license is required. A CCM certificate or equivalent within eighteen months.

Responsibilities

• Manage medical and dental utilization review processes for members.
• Oversee contract deliverables and compliance related to utilization management and care coordination.
• Ensure understanding of Medicaid benefit packages and administer those benefits.
• Identify members with complex needs and coordinate options for management.
• Coordinate care across settings to achieve optimal outcomes.
• Process authorizations for dental and medical referrals, hospitalizations, and home health services.
• Review and optimize levels of care and quality of care in collaboration with leadership.
• Support HIPAA compliance and confidentiality in all processes.
• Attend meetings with department managers to facilitate coordination of care.
• Collaborate with other departments to improve utilization management and care coordination.

Skills

Communication skills

HIPAA compliance

Team collaboration

Education

Bachelor's degree in related field

Tools

Database software

Spreadsheet software

Report writing tools

Project management tools

Word processing

Presentation software

Scheduling software

Job description

Cascade Comprehensive Care Inc. is seeking an experienced Clinical Operations Manager to oversee medical and dental authorizations and care coordination for Medicaid members in Oregon.

The role ensures timely processing, regulatory compliance, and cost-effective service delivery across care settings. The position requires an RN license, a CCM certification within 18 months, and a Bachelor’s degree with 3–5 years of related experience.