RN Care Coordinator

Moda Health; Portland (OR); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated care coordinator to enhance member support and ensure timely healthcare delivery. This role involves developing treatment plans, coordinating with healthcare providers, and maintaining effective communication with members and their families. The ideal candidate will have a strong nursing background, excellent analytical and organizational skills, and the ability to thrive in a fast-paced environment. Join a forward-thinking company that values diversity and is committed to building a healthier future for the community. This full-time work-from-home position offers competitive compensation and comprehensive benefits.

Benefits

401K Matching

Employee Assistance Program

PTO and Company Paid Holidays

Qualifications

• 3+ years of recent hospital, home health, or acute care experience.
• Ability to work under pressure and maintain confidentiality.

Responsibilities

• Coordinate care and develop treatment plans for members.
• Investigate healthcare alternatives and manage caseload effectively.

Skills

Analytical Skills

Problem-Solving

Organizational Skills

Communication Skills

Typing Speed (35 wpm)

Education

Graduate of an accredited nursing program

Current Oregon Registered Nurse license

Tools

Microsoft Office

Job description

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 who share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary

Performs care coordination within the boundaries of the company’s policies and procedures to ensure appropriate care is delivered in a timely manner and within the appropriate setting for members. Interacts with the member, family, and care providers to develop, coordinate, and monitor the member’s treatment plan. This is a FT WFH position.

Compensation

The salary range for this position is $36.19 - $45.24, DOE. Actual pay is based on qualifications. Applicants who do not meet 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.

Benefits

• 401K- Matching
• Employee Assistance Program
• PTO and Company Paid Holidays

Primary Functions

• Investigates opportunities for healthcare alternatives and prepares cost-effective plans to offer patients, families, and providers.
• Identifies health services vendors for Care Coordination and coordinates with providers for member benefits, utilizing community resources when available.
• Works closely with members, families, and providers, typically by phone, to outline a clear, proactive plan of care with patient goals and objectives, including measurements to attain them.
• Uses the company’s internal systems to determine eligibility, benefit plan, and physician networks associated with the member’s plan. Documents case notes accurately and clearly, researches problems, and offers solutions.
• Maintains an acceptable caseload within department guidelines, works scheduled hours to ensure phone coverage between 7 am – 5:30 pm, and meets department standards for case closure and RN audit scores.
• Applies clinical expertise to ensure compliance with medical policy and standards of care during Utilization Review and Service Authorizations.
• Consults with physician advisors for clinical determinations.
• Refers cases to Case Manager RNs for assessment.
• Provides approvals and denials professionally and positively.
• Reports high dollar cases in Rounds meetings.
• Builds professional relationships with internal departments, communicating effectively with support and customer service staff.
• Contributes to fostering a collaborative team environment.
• Performs other duties as assigned.

Required Skills, Experience & Education

• Graduate of an accredited 2-4 year nursing program.
• Current unrestricted Oregon Registered Nurse license.
• At least 3 years of recent hospital, home health, or acute care experience.
• Typing speed of at least 35 wpm and proficiency in Microsoft Office.
• Strong analytical, problem-solving, organizational, and detail-oriented skills.
• Excellent communication skills for interaction with staff, members, and providers.
• Self-starter with the ability to identify training needs.
• Capable of defusing difficult calls and working towards positive resolutions.
• Ability to work under pressure with shifting priorities.
• Maintain confidentiality and professionalism.

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

Moda Health is an equal opportunity employer. We do not discriminate based on race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status, or any other protected status. All employment terms are covered without exception.

For accommodations, please contact Kristy Nehler and Danielle Baker at our [emailprotected] email.