Lead Rn Care Coordinator

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.
We are seeking a Lead RN Care Coordinator. This position maintains Care Coordination caseload and directly oversees care coordination practices for all members involved in care coordination program; monitors workflow and assists with training of RN staff; ensures compliance with Healthcare Services as well as State mandated standards and maintains readiness for accreditation organization audits.
This position is full time PST remote position.

Follow the link below and complete an application for this position.
https://j.brt.mv/jb.do?reqGK=27728097&refresh=true

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Primary Functions:

1. Functions as a Care Coordinator RN, (see Care Coordinator RN position description)
2. Oversees care coordination practices of Care Coordination Team- Government Programs.
3. Maintains caseload within guidelines outlined in Medical Management Production Policy.
4. Assures ongoing compliance with CMS and state mandated standards.
5. Assists RN Trainer and HCS Manager with planning training schedules for new Care Coordinator nurses and assigns mentors/trainers.
6. Monitors training progress of new Care Coordinator Nurses and reports progress to the HCS Manager of Medical Management.
7. Monitors High Dollar Report to ensure compliance with weekly update requirements and reports results to the HCS Manager of Medical Management.
8. 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.
9. Reviews and edits all Policies and Procedures related to Care Coordination program.
10. Functions as liaison and point person for all communication with accreditation organization regarding care coordination.
11. Maintains complete, well organized records of all CMS and State audits, and all communication with auditors regarding to care coordination.
12. Is present for and assists Quality and Compliance Project Manager in facilitating all accreditation organization audits.
13. Identifies problems and researches alternative solutions.
14. Contributes to the department as a team player.

Requirements

1. Requires current unrestricted Oregon Nursing license as a registered nurse.
2. Demonstrated proficiency in all areas of Care Coordination process.
3. Certification in utilization review/management preferred.
4. Must have 3 years recent hospital, home health or acute care experience.
5. Type a minimum of 35 wpm on a computer keyboard.
6. Proficiency with personal computer programs such as Microsoft Word and Excel.
7. Analytical, problem solving, memory retention, organizational and detail oriented.
8. Excellent verbal and interpersonal communication skills including management of the angry customer.
9. Ability to work well under pressure.
10. Ability to come into work on time and daily.
11. Project a professional business image telephonically and in person.

Working Conditions
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.