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Health Plan Care Manager, Portland, OR

Organization: Adventist Health
Category: Manager
Location: Portland, OR
Date Job Posted: January 9, 2020
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Adventist Health
Portland, OR

Health Plan Care Manager (OR)

Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good - from the operating room to the boardroom, we are driven by our unique passion to live God's love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.

We're looking for someone to join our team as a Health Plan Care Manager (OR) who:
Manages the development, implementation and evaluation of the cavitation care management service lines. Enhances the quality of member management by promoting continuity of care and cost effectiveness through whole person in-patient and out-patient management, care integration, case management, utilization review and care planning.

Essential Functions:

  • Partners with internal and external physician advisors, as well as claims department and data management and analytics department to provide safeguards, processes and expected outcomes for the Health Plan's member population. Perform and/or coordinate preventative care, wellness, and nutritional counseling to Members. Develops and maintains positive relationships with customers internal and external.
  • Works collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction initiatives.
  • Performs ongoing collaboration with staff to ensure a member's medical condition meets medical necessity criteria. Communicates changes that could affect the discharge plan of care.
  • Manages communication related to discharge planning and utilization management. Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
  • Performs other job-related duties as assigned.

You'll be successful with the following qualifications:


  • Bachelor's Degree (BSN): Preferred

Work Experience:

  • Nursing experience: Preferred

Required Licenses/Certifications:

  • Cardiopulmonary Resuscitation (CPR): Required
  • Certified Case Manager: Preferred
  • Registered Nurse (RN) licensure in state of practice: Required

To apply to this position, please follow the link:

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