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RN Case Manager in West Linn, OR at KEPRO

Date Posted: 1/17/2018

Job Snapshot

Job Description

Provides on-site (face-to-face) and telephonic outreach, behavioral health,disease and/or case management, and education and support to plan membersparticipating in the Oregon Health Plan Care Coordination (OHPCC) program withthe goal of supporting healthy lifestyle choices and to reduce long termeffects of chronic illness. The individual in this role performs otherclinically based activities to assist in the coordination of care between themember, their provider(s) and community-based health organizations.

  • Provides on-site and telephonic outreach,disease management and/or case management, education and other clinically basedactivities to OHPCC members.
  • Conducts assessments, develops treatment plansand interventions, and sets goals for treatment plans and behavioralmodification within their scope of practice.
  • Collaborates with the member’s medical andhealth community-based providers (that may include the primary care provider(PCP), specialist provider, behavioral specialists, or others as may beindicated) regarding the member’s treatment needs and plan of care. Thefrequency of contact is determined based on the member’s acuity ranking andclinical need. 
  • Collects clinical data and enters informationinto the OHPCC operating system database for tracking and metric purposes.
  • Routinely documents all member interactions inthe OHPCC operating system database to ensure a longitudinal record ismaintained of all member interactions.
  • Monitors and evaluates the services andcommunity-based resources necessary to respond to the member’s individualhealthcare needs.
  • Ensures day-to-day processes are conducted inaccordance with nationally accepted standards (NCQA, URAC and other regulatorystandards).
  • Fosters positive and professional relationshipsand acts as a liaison with internal and external customers to ensure effectiveworking relationships.
  • Maintains medical records confidentiality atall times through the proper use of computer passwords, maintenance of securedfiles; adherence to HIPAA guidelines and policies.
  • Utilizes proper telephone and personaletiquette and judicious use of other verbal and written communications,following KEPRO policies, procedures and guidelines.
  • Follows KEPRO telecommuting policies andprocedures as a member of the field-based staff.
QUALIFICATIONS

  • A minimum of an Associate degree as aRegistered Nurse required; Bachelor’s degree as a nurse or in a relatedhealth care field; preferred.
  • Current unrestricted nursing license required; Professional certification (CCMor CCP); preferred
  • Minimumof three (3) years clinical experience; required.
  • Priorexperience in case management, quality improvement medical records review,disease management and/or case management; preferred.
  • Previousexperience in behavioral health; long-term care, assisted care, and/or workingwith disabled persons; strongly preferred. 
  • Must be able and willing to travel and have anactive and unrestricted driver’s license, reliable transportation and activeautomobile insurance; required.
  • Clinical assessment skills, consistent withstate licensure scope of practice requirements; required.
  • Ability to assess patient health status,consistent with state licensure scope of practice requirements; required.
  • Able to prioritize and target interventions,consistent with state licensure scope of practice requirements; required.
  • Professional verbal and written communicationskills, with the ability to clearly articulate thoughts and ideas; required.
  • Organizational skills with the ability tohandle multiple tasks and/or projects at any one time; required.
  • Customer service skills with the ability tointeract professionally and effectively with providers, third party payers,physicians, and staff from all departments within and outside of KEPRO;required.
  • Strong telephonic communication andinterviewing skills; required.
  • Analytical and interpretation skills including departmental,utilization, financial and operations data; required
  • Decision-making skills with the ability toinvestigate and weigh alternatives, integrate data, and select the mostappropriate course of action that meets the best-interests of the member andprovides the greatest benefit to the organization; required

KEPRO offers challenging careers, excellent benefits andopportunities for advancement.  For consideration, please submit resumeand cover letter with salary requirements. Only those candidatesidentified for an interview will be contacted. No Phone CallsPlease.  Visit our website at www.kepro.com for more information on the KEPRO Family ofCompanies.  

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet basedsystem operated by the Department of Homeland Security (DHS) in partnershipwith the Social Security Administration (SSA) that allows participatingemployers to electronically verify the employment eligibility of their newlyhired employees in the United States.



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