Case Manager

Lets do great things together!

About Moda

Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were 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. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.

Position Summary

The Case Manager performs case management within the boundaries of accreditation organization standards to ensure appropriate care is delivered timely and within the appropriate setting for Moda Health and Summit Health members. Interacts with the member family and care providers to develop coordinate and monitor the members treatment plan. This is a FT WFH role.

Pay Range

$70579.27 - $88224.08 annually (depending on experience)

• This role may be classified as hourly (non-exempt) depending on the applicants location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page linked below to be considered for this position.

Dental Vision Pharmacy Life & Disability

Required Skills Experience & Education :

Graduate of accredited school of Nursing or Social Work.

Requires current unrestricted Oregon license as a Registered Nurse or Social Worker (LMSW LCSW).

Certification in case management (CCMC) required or ability to obtain within 24 months of hire.

Must have recent healthcare experience in acute care and and / or skilled nursing care. To include medical surgical and behavioral health knowledge and experience.

Proficient with Microsoft Office applications and type a minimum of 35 wpm on a computer keyboard.

Strong analytical problem solving memory retention organizational and detail orientation skills.

Exceptional verbal and interpersonal communication skills including management of the angry customer.

Ability to work well under pressure.

Project a professional business image telephonically and in person.

Ability to come in to work on time and on daily basis.

Primary Functions :

Responsible for essential activities of case management including assessment planning implementation coordination monitoring and evaluation.

Assessment : collection of in-depth information about a members situation and functioning to identify individual needs and barriers to overcome.

Planning : identification of specific objectives goals and actions designed to meet the members needs as identified in the assessment.

Coordination : organization securing integrating and modifying resources.

Monitoring : gathering sufficient information to determine the plans effectiveness and the evaluation phase should determine the effectiveness of reaching the desired outcomes.

Utilizes evidence-based criteria that incorporates current and validated clinical research findings.

Consults with physician advisors to ensure clinically appropriate determinations.

Serves as a resource to internal and external customers.

Collaborates with other departments to resolve claims quality of care member or provider issues.

Identifies problems or needed changes recommends resolution and participates in quality improvement efforts.

Responds in writing or by phone to members providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.

Provides consistent accurate and timely documentation.

Plans organizes and prioritizes assignments to comply with performance standards corporate goals and established timelines.

Other duties and responsibilities as assigned.

Working Conditions & Contact with Others

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. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.

For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.

Required Experience :

Manager

Key Skills

Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling

Employment Type : Full-Time

Experience : years

Vacancy : 1

Yearly Salary Salary : 70579 - 88224