RN Care Coordination Lead, Hybrid (Portland)

Moda Partners, Inc.; Portland (OR); Hybrid; USD 86,000 - 110,000; Full time

Job summary

Moda Health in Portland, OR, seeks an RN Care Coordination supervisor for a full-time hybrid role. You will lead the RN Care Coordination team, oversee utilization management, and ensure quality with NCQA and CMS standards. The position emphasizes training, audits, and performance reporting.

Requirements include an Oregon RN license and a nursing degree, with at least 3 years in care coordination or utilization management. Strong analytical, communication, and MS Word/Excel skills are essential.

Qualifications

• Requires current unrestricted Oregon RN license and degree from accredited nursing program.
• Minimum 3 years in Utilization Management, Care Coordination or Case Management in health plan or similar.
• Supervisory/leadership experience in medical/health insurance setting required.
• Analytical, detail oriented with problem solving and organizational skills.
• Proficiency with Word and Excel; typing 35 wpm+.

Responsibilities

• Lead and supervise RN Care Coordination team; oversee utilization management program.
• Develop, train, and coach staff; monitor performance against NCQA and CMS standards.
• Manage workflows, audits, and reporting of cost savings and productivity.
• Coordinate with providers and departments to ensure integrated care management.

Skills

RN license

Supervisory

Utilization Mgmt

Analytical thinking

MS Word/Excel

Communication

Education

BSN or higher

Tools

Microsoft Word

Excel

Job description

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary
This is a FT hybrid position based in Portland, Oregon. Leads and supervises RN Care Coordination team. Oversees commercial and individual plan medical utilization management program by managing workflow, training staff, auditing quality, and reporting cost savings, productivity, and other performance measures.

Pay Range
$86,486.08 - $110,265.00annually (depending on experience) *Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27786712&refresh=true

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

1. Requires current unrestricted Oregon RN license, and degree from accredited school of nursing
2. Supervisory, management or lead experience in a medical and/or health insurance setting is required.
3. Minimum 3 years of Utilization Management, Care Coordination or Case Management experience with health plan or similar organization.
4. Analytical and detail oriented, with demonstrated initiative, problem solving, organizational, and critical thinking skills.
5. Proficiency with Microsoft Word and Excel is required, with typing speed of 35 wpm or better.
6. Excellent verbal, written and interpersonal communication skills.Demonstrated skill in speaking and presenting to groups.
7. Ability to work well under pressure.
8. Ability to maintain confidentiality and project a professional business image.
9. Ability to come in to work on time and daily.

Primary Functions:

1. Ensures department standards and goals are achieved through training, delegating, and coaching of staff.Develops, maintains, and reports performance measures for work team.Monitors through training and auditing to assure compliance with NCQA and CMS standards.
2. Supervises clinical staff providing daily work direction, vacation scheduling, monitoring attendance, giving performance reviews, hiring, and training new employees.
3. Determines and implements an organized and systematic management plan for handling such cases.
4. Develops programs with acute care coordination component.Understands the care coordination environment and facilitates integrating chronic disease programs into day-to-day workflow.
5. Assists Manager with development and implementation of utilization management and care coordination programs
6. Participates in internal and external audits
7. Ensures comprehensive communication and integration with all medical management and case management programs and functions.
8. Monitors and reports on program outcomes, value, performance, and quality, ensuring accuracy and timeliness.
9. Establishes contacts with health care vendors and coordinates with providers when necessary to achieve case management and care coordination objectives.
10. Establishes effective, collaborative working relationships with peers within department and with all other departments.
11. Develops and implements staff development & education curricula.Facilitates and coordinates weekly team meetings.
12. Performs other duties as assigned.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
• Internally with all departments. Externally with providers, provider offices, members, and groups.
  

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our [e-mail] email.