Description:

OVERVIEW:

The Case Manager/Care Coordinator will work to assist NWP clinicians, KPNW members and community clinicians in the coordination of medical services between Kaiser Permanente and community providers and facilities. Includes interfacing with NWP clinicians, community providers and members to ensure the member receives high quality, safe, efficient and timely medical services.

JOB DUTIES:

• Includes interfacing with NWP clinicians, community providers and members to ensure the member receives high quality, safe, efficient and timely medical services

• Preview and preapprove requests for referral to community clinicians and/or programs for medically necessary services as requested by the NWP clinician.

• Work directly with the member and the community clinician to coordinate medical services within KPNW, providing accurate and timely information to the community physician and member related to requested services.

• Maintain knowledge base of resources available within the community and Kaiser Permanente assists with arranging for medical services in the appropriate location.

• With Community Medicine Integration Center leadership, insures compliance with regulatory and accrediting requirements for utilization of referred services, including NCQA, MDQR, Federal and State agencies.

• Maintains knowledge of Kaiser Permanente policies, procedures and benefits

JOB ID: KAISJP00211317

LOCATION: Kaiser Permanente Building, Care & Coverage - 500 NE Multnomah St, Portland, OR 97232

SCHEDULE: Monday - Friday, 8:00 AM - 4:30 PM (40 hours/week)

ASSIGNMENT LENGTH: 3 Months (opportunity for extension)

Skills:

case management, utilization management, utilization review, medical, concurrent review, discharge planning, care management, patient care, RN, care coordination, Insurance, medicare, medicaid, Health care, Acute care, Managed care, Registered Nurse, nurse, nursing, population care, case management principles, Oregon Health Plan, ORS Requirements, Pharmacy rules, Pharmacy Regulations, occupational requirements survey, treatable diseases, community resources, community health, quality management, quality management system, utilization management principles, BLS, Basic Life Support, American Heart Association

Top Skills Details:

case management,utilization management,utilization review,medical,concurrent review,discharge planning,care management,patient care,RN,care coordination,Insurance,medicare,medicaid

Additional Skills & Qualifications:

MUST HAVES:

• Current Oregon and Washington RN license

• Basic Life Support certification (BLS) - MUST be through the American Heart Association!

• High School Diploma or GED

• COVID-19 Vaccine

• Valid Driver's License

• EMR/EHR experience

• Minimum two (2) years of experience in case management, care coordination, or population care.

• Minimum two (2) years of direct patient care as a registered nurse.

• Knowledge of case management principles.

• Knowledge of Oregon Health Plan, including ORS requirements, pharmacy rules and regulations and OHP list of treatable diseases.

• Knowledge of community resources for the care of the elderly and disabled.

• Demonstrates customer-focused service skills.

• Demonstrated ability to organize, coordinate, and manage care plans. Thorough knowledge of levels of care within outpatient, acute

care, and extended care settings.

• Demonstrated ability to work as part of a multidisciplinary team.

• Excellent written and verbal communication skills.

• Ability to present reports verbally in a public setting (public speaking).

• Demonstrated data entry skills and ability to use Microsoft Word software.

• Ability to work independently and efficiently under pressure

Best v. Avg:

• Prior experience serving the mentally ill and or individuals with substance abuse issues.

• Prior experienced as a care coordinator or discharge planner. Knowledge of the Kaiser Permanente system, including HealthConnect.

• Knowledge of Medicaid/Medicare programs and regulations.

• Knowledge of quality management and utilization management principles.

• Professional certification as a case manager.

• Prior experience in working in Kaiser Permanente

Experience Level:

Intermediate Leve

About Actalent:

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.