Lead RN Care Coordinator (Internal Applicants Only) - Portland, OR
Moda Health
- Portland, OR
- $81,476 per year
- Permanent
- Full-time
- Medical, Dental, Vision, Pharmacy, Life, & Disability
- 401K- Matching
- FSA
- Employee Assistance Program
- PTO and Company Paid Holidays
- Oversees care coordination practices of Care Coordination Team- Government Programs.
- Maintains caseload within guidelines outlined in Medical Management Production Policy.
- Assures ongoing compliance with CMS and state mandated standards.
- Assists RN Trainer and HCS Manager with planning training schedules for new Care Coordinator nurses and assigns mentors/trainers.
- Monitors training progress of new Care Coordinator Nurses and reports progress to the HCS Manager of Medical Management.
- Monitors High Dollar Report to ensure compliance with weekly update requirements and reports results to the HCS Manager of Medical Management.
- Periodically audits cases in care coordination program for compliance with accreditation organization standards, and reports results to clinical Supervisor and Manager of Medical Management Team.
- Reviews and edits all Policies and Procedures related to Care Coordination program.
- Functions as liaison and point person for all communication with accreditation organization regarding care coordination.
- Maintains complete, well organized records of all CMS and State audits, and all communication with auditors regarding to care coordination.
- Is present for and assists Quality and Compliance Project Manager in facilitating all accreditation organization audits.
- Identifies problems and researches alternative solutions.
- Contributes to the department as a team player.
- Demonstrated proficiency in all areas of Care Coordination process.
- Certification in utilization review/management preferred.
- Must have 3 years recent hospital, home health or acute care experience.
- Type a minimum of 35 wpm on a computer keyboard.
- Proficiency with personal computer programs such as Microsoft Word and Excel.
- Analytical, problem solving, memory retention, organizational and detail oriented.
- Excellent verbal and interpersonal communication skills including management of the angry customer.
- Ability to work well under pressure.
- Ability to come into work on time and daily.
- Project a professional business image telephonically and in person.
Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Occasional driving for meetings outside of the office. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.Contact With Others
Internally with own department, Medical and Dental Customer Service, Professional Relations, Marketing, Medical Claims, Actuarial (Underwriting), Information Systems and Human Resources. Externally with accreditation organization, providers, provider offices and hospitals, 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.For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.Pay Range$81,475.80 Annually to $101,856.32 Annually