Supervisor, Care Coordinator

Moda Health; Portland (OR); Hybrid; USD 86,000 - 110,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy,Life

401K- Matching

FSA

Employee Assistance Program

PTO and Holidays

Job summary

Moda Health is seeking a FT Hybrid RN Care Coordination Supervisor based in Portland, OR. You will lead the RN Care Coordination team and oversee medical utilization management programs for commercial and individual plans.

The role demands an Oregon RN license, 3+ years in utilization management or care coordination, and strong analytical, communication, and leadership skills. Hybrid work with competitive pay and benefits are offered.

Qualifications

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

Responsibilities

• 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 for NCQA and CMS standards.
• Supervises clinical staff including daily work direction, scheduling, attendance, performance reviews, hiring and training.
• Implements organized management plans for handling cases and coordinating care.
• Develops programs with acute care coordination components and integrates chronic disease programs.
• Assists Manager with development and implementation of utilization management and care coordination programs.
• Participates in internal and external audits.
• Ensures communication and integration with all medical management and related programs.

Skills

RN License

Supervisory Experience

Utilization Management

Analytical Skills

Typing 35 wpm

Communication Skills

Work Under Pressure

Confidentiality

Punctuality

Education

RN license and nursing degree

Tools

Microsoft Word

Microsoft Excel

Job description

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.

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 - $110,265.00 annually (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.

Benefits

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

Required Skills, Experience & Education

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

Primary Functions

• 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.
• Supervises clinical staff providing daily work direction, vacation scheduling, monitoring attendance, giving performance reviews, hiring, and training new employees.
• Determines and implements an organized and systematic management plan for handling such cases.
• Develops programs with acute care coordination component. Understands the care coordination environment and facilitates integrating chronic disease programs into day-to-day workflow.
• Assists Manager with development and implementation of utilization management and care coordination programs
• Participates in internal and external audits
• Ensures comprehensive communication and integration with all medical management and case management programs and functions.
• Monitors and reports on program outcomes, value, performance, and quality, ensuring accuracy and timeliness.
• Establishes contacts with health care vendors and coordinates with providers when necessary to achieve case management and care coordination objectives.
• Establishes effective, collaborative working relationships with peers within department and with all other departments.
• Develops and implements staff development & education curricula. Facilitates and coordinates weekly team meetings.
• 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.