Providence St. Joseph Health is calling a Registered Nurse (RN) Care Coordinator Case and Disease Management to our location in Beaverton, OR.
We are seeking a Registered Nurse (RN) Care Coordinator Case and Disease Management to provide care coordination services to Providence Health Plans (PHP) members. Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease. Case management including: triage and referral, transition of care planning, end of life care planning, other acute and catastrophic case management. 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. Care management services include 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. This position works within the health plan framework of managing medical expenses while also working to improve access and quality care to our members.
In this position you will have the following 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.