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Moda Health RN Manager Healthcare Services -- RN Case Management in Portland, Oregon

RN Manager Healthcare Services -- RN Case Management

Job Title

RN Manager Healthcare Services -- RN Case Management






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Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda Health is seeking a Manager in our Healthcare Services department for Care Management. This position provides operational leadership for the care coordination, clinical disease management and case management functions; serves as a clinical advisor for staff to ensure the clinical quality and efficacy of member-facing efforts; develops and implements plans required to meet the care needs of Plan members.

Primary Functions:01. Oversees the non-UM-related care coordination, clinical disease management and case management functions 02. Develops and oversees the implementation of strategies to improve plan performance in terms of utilization, patient access, cost, compliance with contractual quality measures, etc.03. Participates in clinical strategy development and implementation. Collaborates with both internal and external stakeholders to develop and implement strategic clinical and administrative goals. 04. Identifies financial, access and utilization data needs as indicated and coordinates analyses to improve care outcomes05. Promotes quality outcomes and measurement of those outcomes. Prepares routine and ad hoc reports regarding issues related to Care Management practice.06. Recommends and implements action plans to improve clinical service delivery, educate providers, resolve quality improvement issues, and ensure accuracy of data used by CMSor similar organizations.07. Align improvement activities with quality and financial goals.08. Establishes and implements departmental policies, goals, objectives and procedures09. Demonstrates responsible management of all departmental resources. Continuously assesses measures and improves departmental performance. Ensures that the professional development needs of staff are met.10. Performs other duties as assigned.

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

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.

Required Skills

• Bachelor's of Science in Nursing or closely related field

• Five (5) years of experience in health care service delivery

• Three (3) years of experience in Utilization Management, Care Coordination and/or Case Management – preferably with a health care insurance plan

• Experience with the application of standards of care, criteria and guidelines

• Experience managing people and projects

• Demonstrated success driving change in the healthcare delivery system, from either a provider or plan perspective.

• Strong project management, clinical data and financial analysis skills.

Required Certificates, Licenses and Registrations:

• Registered Nursing degree or other health professional degree.

• Active, unrestricted State of Oregon license.