- Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring and evaluation.
- Assessment: collection of in-depth information about a member's situation and functioning to identify individual needs.
- Planning: identification of specific objectives, goals, and actions designed to meet the member's needs as identified in the assessment.
- Implementation: execution of the specific case management activities that will lead to accomplishing the goals set forth in the plan.
- Coordination: organization, securing, integrating and modifying resources.
- Monitoring: gathering sufficient information to determine the plan's effectiveness and the evaluation phase should determine the effectiveness of reaching the desired outcomes. Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care. Utilizes evidence-based criteria that incorporates current and validated clinical research findings. Practices within the scope of their license.
- Consults with physician advisors to ensure clinically appropriate determinations.
- Serves as a resource to internal and external customers.
- Collaborates with other departments to resolve claims, quality of care, member or provider issues.
- Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.
- Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.
- Provides consistent and accurate documentation.
- Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines.
- Palliative care experience preferred
- Knowledge of health insurance industry trends, technology and contractual arrangements.
- General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
- Strong oral, written and interpersonal communication and customer service skills.
- Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.
- Strong organization and time management skills with the ability to manage workload independently.
- Ability to think critically and make decision within individual role and responsibility.
-
Nursing Service Management
1 week ago
Stellar Enterprises Cedar Hills, OR, United States FreelanceCedar Hills, OR based Deutsche Fachpflege Gruppe provides care for individuals who require non-clinical intensive care. Our clients - young or old - are cared for in their own homes or in modern living communities by our professional and highly motivated nursing staff. The qualit ...
-
Registered Nurse
3 days ago
Aveanna Healthcare Vancouver, United StatesAveanna Healthcare, the largest pediatric home health care company in the U.S., is hiring compassionate Registered Nurses (RN) to provide skilled nursing care to patients in the home setting. We are the hearts of 40,000 caregivers and trusted by over 33,000 families. · Pay rate: ...
-
Licensed Practical Nurse
3 days ago
Aveanna Healthcare Vancouver, United StatesLicensed Practical Nurse (LPN) · Aveanna Healthcare, the largest pediatric home health care company in the U.S., is hiring compassionate Licensed Practical Nurses (LPN) to provide skilled nursing care to patients in the home setting. We are the hearts of 40,000 caregivers and tr ...
-
Nursing Service Management
3 days ago
Titan Ventures Scappoose, United StatesAre you a dedicated nursing manager looking for a new challenge in Scappoose? If you value respectful interactions and a harmonious work environment, if you are seeking a strong team that strives for greatness together, if appreciation and recognition motivate and inspire you, an ...
-
Nursing Department Management
2 days ago
NebulaTech Gresham, United StatesHead of Nursing 39 h/week · The Caritas Association Nuremberg is currently seeking a Head of Nursing to join our team as soon as possible. · Your responsibilities: · You are responsible for ensuring and maintaining high quality care and support · You plan and organize staff a ...
-
Manager, Clinic Department Registered Nurse
1 week ago
Kaiser Permanente Vancouver, United States: Job Summary: · Manages daily operations for all back office clinical and related business functions for a department within a medical clinic and, as assigned, may also manage other regional initiatives. The Medical Department Manager is responsible for assigned department clin ...
-
Manager, Clinic Department Registered Nurse
1 week ago
Kaiser Permanente Vancouver, United StatesJob Summary: · Manages daily operations for all back office clinical and related business functions for a department within a medical clinic and, as assigned, may also manage other regional initiatives. The Medical Department Manager is responsible for assigned department clinica ...
-
Nursing Home Care Management
2 days ago
Spectrum Dynamics Damascus, United StatesWE ARE... a new, modern, and innovative facility of the Caritas Association of the Archdiocese of Munich and Freising e.V. The Marienstift is located in the municipality of Gauting in the district of Starnberg, in a central location with excellent transportation and S-Bahn connec ...
-
Eclipse Enterprises Dunthorpe, United StatesAre you passionate about helping people in your nursing profession and value joy in your work? · ▸ If respectful interaction in the workplace is important to you · ▸ If you are looking for a strong team and a good working atmosphere · ▸ If appreciation and recognition motivate yo ...
-
MAT Co-Care Nurse Care Manager
6 days ago
SeaMar Community Health Centers Vancouver, United StatesSea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service ...
-
Kaiser Clackamas, United States Full timeJob Summary: · The Surgical Services Associate Manager is responsible for providing support and assistance to the Manager for the daily operations of surgical services of that center including OR, SPU/PACU and Endoscopy. The Associate Manager reports to the Manager of Surgical S ...
-
MAT Co-Care Nurse Care Manager
2 days ago
Sea Mar Community Health Centers Vancouver, United StatesJob Description · Job DescriptionSea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse comm ...
-
Medical assistant
2 days ago
Quantum Ventures Salmon Creek, United StatesThe University Hospital Münster is one of the leading hospitals in Germany. We need you and your commitment and offer you numerous opportunities for professional development. We are looking for a Medical Assistant (MFA) (m/f/d*) for the Intensive Therapy Station of the Clinic for ...
-
Molina Healthcare Vancouver, WA, United StatesJOB DESCRIPTION · Job Summary · Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for me ...
-
Nursing Manager
2 days ago
Cross Country Search Portland, United StatesRN - Nurse Manager - Inpatient Services · Fulltime, Mon-Fri business hours · Comprehensive benefits package · Cross Country Search has partnered with a hospital in Portland, Oregon looking to add a Registered Nurse Manager for a critical care unit. Registered Nurses interested in ...
-
Nurse Manager
2 days ago
SCA Health Portland, United StatesOverview: · Oregon Outpatient Surgery Center is a state of the art ambulatory surgery center (ASC) jointly owned managed by SCA Health. We have 3 operating rooms to provide patients with variety of surgical care needs. We are a fast-paced, high quality and safety centered outpat ...
-
Molina Healthcare Vancouver, WA, United StatesMolina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. ...
-
Assistant Nurse Manager
4 days ago
Providence Portland, United StatesDescription · Assistant Nurse Manager at Providence Office Park Portland (Full time and Evening shift) · $8,000 hiring/sign-on bonus for eligible external hires that meet required qualifications and conditions for payment. · The Assistant Nurse Manager in the Patient Logistics Ce ...
-
Radiology Nurse Manager
14 hours ago
OHSU Portland, United StatesDepartment Overview · OHSU is proud to be designated a Magnet hospital by the American Nurses Credentialing Center. Just 9 percent of U.S. healthcare organizations hold this designation. We pride ourselves in not only serving our community with the highest of accolades but also p ...
-
Assistant Nurse Manager
1 day ago
Legacy Health Portland, OR, US, United StatesNurses at Legacy embody our mission of making life better for others. It's evident in their expertise as well as in their kind and caring nature. The Assistant Nurse Manager leads by example, providing support to the Nurse Manager in overseeing patient care and carrying the Legac ...
Care Management Nurse - Vancouver, United States - Cambia Health Solutions, Inc
Description
Care Management Nurse - Hybrid
WA or OR - Vancouver Clinic
Primary Job Purpose
The Care Management Nurse provides clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member's care to assess, plan, implement, coordinate, monitor and evaluate care as needed.
General Functions and Outcomes
Minimum Requirements
Normally to be proficient in the competencies listed above
Care Management Nurse would have a/an Associate or Bachelor's Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience.
Required Licenses, Certifications, Registration, Etc.
Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care
Must have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Master's degree in Behavioral Health preferred for behavioral health care management); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)
Work Environment
Duties performed at home and in Vancouver Clinic
