Job Information

Providence Clinical Program Coordinator RN (Remote: SW WA / OR) in Beaverton, Oregon

Description

Providence is calling a Clinical Program Coordinator RN who will:

  • Provide care coordination, case management & care management services to Providence Health Plans(PHP) members

  • Care coordinationincludes: disease management programs, including educating, motivating and empowering members to manage their disease

  • Case management includes: triage and referral, transition of care planning, end of life care planning, other acute and catastrophic case management

  • Care management services includes: nurse education, care coordination and general assistance with managing day to day functional needs; assisting with the management of member health plan benefits and offering assistance finding alternative services when benefits are exhausted

  • These services are offered to members and their families who have acute and complex health care needs; members with chronic conditions at risk for poor health outcomes and members who are terminal and nearing end of life.

  • Work within the health plan framework of managing medical expenses while also working to improve access and quality care to our members

We welcome 100% remote work for residents of SW Washington and Oregon.

Primary Responsibilities:

  • Participate in discharge planning, care coordination and post hospital follow up calls for hospitalized members, following department policies and procedures

  • Maintain professional working relationships with health care providers and facilities, case managers, community liaison staff and members and families when providing care coordination services and health education

  • Perform the six essential activities of case management: assessment, coordination, planning, monitoring, implementation and evaluation, in multiple environments

  • Perform case management duties to effectively manage services, benefits, costs and quality, following policies and procedures as outlined

  • Provide disease management programs and services following policies and procedures as outlined

  • Track and report case management activities, savings and outcomes as outlined in the policies and procedures

  • Screen members through a Health Risk Assessment (HRA) for case and disease management programs and services

  • Review high cost reports and member utilization experience and prepare clinical reports outlining the member diagnosis, prognosis and treatment, following established procedures

  • Participate in program development, clinical supervision and continuing education

  • Exceptional Needs Care Coordinator (Specialized services provided to Oregon Health Plan members who are Aged, Blind or Disabled) duties include: Early identification of those Aged, Blind, Disabled DMAP members that have disabilities or complex medical care needs, Assist members to ensure timely access to providers and services, Assist providers with coordination of services and discharge planning to meet the unique needs of disabled members, Assist with coordinating community support and social service systems linkage with medical care systems, as necessary and appropriate, Act as an internal resource regarding knowledge of Oregon Health Plan to the Providence Health System, Participate and represent Providence Health Plans at state, county, and community agency meetings throughout the service areas

Additional Responsibilities:

  • Assist in the development of department polices and procedures

  • Identify quality of care issues for review, as outlined in department procedures

  • Provide training and expertise, when asked, on medically related issues

  • Maintain a thorough knowledge of managed care and other health plan departments including: QMM medical management programs, regulatory standards related to care coordination and quality, provider network and credentialing, medical review and claims audit programs

  • Identify internal and external customers; determine customer needs and meet those needs

  • Represent the organization in a professional manner, supporting the programs, goals and objectives; support the mission and be a role model for others, as a team member and a professional. Maintain personal and professional development

  • Assure confidentiality is maintained regarding health information, health status, medical records, claims and employee records, per the confidentiality policies and procedures

Required qualifications for this position include:

  • 5 years clinical nursing experience

  • Experience working with physicians in collaboration and management of patient care

Preferred qualifications for this position include:

  • Bachelor's Degree in Nursing or health education

  • Current nursing experience in the following areas: cardiology, endocrinology, pediatrics, obstetrics, oncology, respiratory, health education

  • Oregon Registered Nurse License - Upon Hire (Vendor Managed)

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 118959
Company: Providence Jobs
Job Category: Clinical Administration
Job Function: Clinical Support
Schedule: Full time
Shift: Day
Career Track: Nursing
Department: 5018 HCS CASE AND DISEASE GOV PRGM OR REGION
Address: OR Beaverton 3601 SW Murray Blvd

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.