Care Manager, Portland, OR
Shriners Hospitals for Children – Portland, Oregon
Shriners Hospitals for Children – Portland is currently seeking a Care Manager for a full-time (1.0 FTE) position.
The Care Manager (CM) requires a thorough understanding of clinical, financial, administrative and psychosocial components of care management. The CM is responsible for providing assessments, planning, interventions and follow-up for patients across the continuum of care to facilitate the creation of, and adherence to, a treatment plan aimed to reach optimum health. Working with a multidisciplinary team, the successful candidate will proactively address needs identified through screening to ensure care transitions are safe, seamless and coordinated.
- Advocates for the patient and his/her family while adhering to the overall treatment plan, UR/UM guidelines, policies and procedures of Shriners Hospitals for Children, regulatory requirements, and nursing and case management standards of practice.
- Performs assessments on assigned population and develops plans based on the needs of the patient/family.
- Works collaboratively with the interdisciplinary team to promote high quality care provided in a timely and fiscally responsible manner. Ensures that the patient’s care is coordinated across the continuum by collaborating and communicating with the patient’s medical home and/or other healthcare providers.
- Identifies barriers that impact adherence to the plan of care and provides intervention or makes referrals as indicated.
- Provides clinical information as needed to assist in obtaining authorization for services; ensures admission, surgery, and designated level of care orders reflect medical necessity documentation. Obtains authorizations for post SHC care and services as required by patient’s benefits, entitlement programs, or charitable resources.
- Provides guidance about health care benefits and assesses financial barriers; addresses gaps in healthcare coverage and makes referrals as needed.
Education: Successful candidates will have BSN, MSN preferred.
Experience: At least 5 years of pediatric clinical experience, preferably in one or more of the hospital’s service lines (orthopedics, neuromuscular conditions, post burn, cleft lip palate revisions)); 3-5 years in Care /Case Management applying a working knowledge of community resources, entitlement programs; working with uninsured/underinsured patient populations is preferred. In addition, experience with utilization review/management with a working knowledge of InterQual criteria is strongly preferred. Experience with disease management, application of motivational interview techniques and competency in computerized documentation systems is required.
Certification/Licensure: Unrestricted RN license in Oregon. Current Case Management Certification by CCM or ACM, or certification obtained within 6 months of employment
Please email resume to firstname.lastname@example.org