Clinical Care Manager RN I

Summary

• JOB SUMMARY/PURPOSE

  • Assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual's health needs. Applies knowledge of applicable regulations, identifies resources (internal or community partners) and eliminates barriers where possible. Provides care management interventions and seamless support across transitions of care. Works with cases that have a low to moderate level of service intensity.

• DEPARTMENT DESCRIPTION

  • Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.

• EXPERIENCE/EDUCATION/QUALIFICATIONS
  • Current unencumbered Oregon RN License required. BSN preferred.
  • One (1) year clinical nursing experience required.
  • Experience or training in the following required:
    • Health care delivery systems and/or managed care patients.
    • Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
  • Experience in the following preferred:
    • Case management.
    • Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
• KNOWLEDGE/SKILLS/ABILITIES
  • Communication - Effective written and verbal communication skills provided to members, providers and organization staff. Able to tactfully discuss issues, and listen to and understand complex information/situations. Ability to apply motivational interview techniques when working with members. Proactively resolve conflicts in positive and constructive manner.
  • Confidentiality - Knowledge of State and Federal (HIPAA) laws pertaining to confidentiality of protected health information. Ability to comply with laws and maintain confidentiality of patient information.
  • Critical Thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions in a member centric manner.
  • Social Perceptiveness - Ability to work with a diverse population from pediatrics to geriatrics. Basic understanding of age-related differences in caring for and/or communicating with members and caregivers. Possess personal sensitivity to the needs and experiences of others and a non-judgmental attitude towards persons of differing standards, values, lifestyles, and ages.
  • Knowledge of Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Ability to appropriately apply evidence based clinical practice and criteria to authorization requests.
• PHYSICAL DEMANDS

  • Rarely
    (1 - 10% of the time)

    Occasionally
    (11 - 33% of the time)

    Frequently
    (34 - 66% of the time)

    Continually
    (67 - 100% of the time)

    CLIMB - STAIRS

    LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

    LIFT (Knee to chest: 24"-54") 0 - 20 Lbs

    LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

    CARRY 1-handed, 0 - 20 pounds

    BEND FORWARD at waist

    KNEEL (on knees)

    STAND

    WALK - LEVEL SURFACE

    ROTATE TRUNK Standing

    REACH - Upward

    PUSH (0 - 20 pounds force)

    PULL (0 - 20 pounds force)

    SIT

    CARRY 2-handed, 0 - 20 pounds

    ROTATE TRUNK Sitting

    REACH - Forward

    MANUAL DEXTERITY Hands/wrists

    FINGER DEXTERITY

    PINCH Fingers

    GRASP Hand/Fist