Providence Health & Services Clinical Case Manager (RN) - Utilization Review Quality Management in Newberg, Oregon
Providence is calling a Registered Nurse Clinical Case Manager (RNCCM) - Utilization Review Quality Management (1.0 FTE, Days) to Providence Medical Group Newberg in Newberg , OR
Shift: Monday through Friday 8am - 5pm
Apply today! Applicants that meet qualifications will receive a text message with some additional questions from our Modern Hire system.
We are seeking a Registered Nurse Clinical Case Manager (RNCCM) - Utilization Review Quality Management that will provide care management and care coordination services for at-risk patients, including patients with complex medical and psychosocial issues. Population-based, chronic care management approaches and application of clinical protocols are integral to the program. This position is a core member of the patient centered medical home (PCMH) teams led by the physician/provider. Assure a systematic approach to the coordination of health and social services for patients along the care continuum in order to improve the patient experience, contain health expenditures and improve quality, and optimize wellness. Assist providers in effectively addressing risk stratified populations, developing a patient centered care plan, and coordinating access to appropriate care and services in an effort to improve or maintain the patient's functional status and independence. Performs all duties in a manner which promotes team work and reflects the Sisters of Providence mission, and core values.
In this position you will have the following responsibilities:
Use a systematic process and clinical skills to assess, plan, implement and evaluate an individual plan of care for a patient that spans the continuum of care. The plan of care is developed in conjunction with the PCMH, the patient and/or the patient's representative
Use principles of utilization management in the decision-making process to assure both quality and cost-effectiveness
Consider alternatives to requested care. Acts as a patient advocate to assure that needed health services are provided in a timely manner
Identify, research and/or refers potential quality of care issues
Monitor and reassess the plan of care to ensure that quality, utilization, and goal achievement are appropriate and cost-effective
Demonstrate positive interactions with stakeholders, i.e. patients, and caregivers so that productivity and coordination of services are maximized
Actively support continuous quality improvement and population disease management activities
Participate in clinical protocol and guideline development
Participate in clinical protocol and guideline development
Maintain, update and improve clinical expertise and care management skills
Offer applicable and appropriate education/coaching with patient, family, and staff regarding chronic care management, and community support systems to meet social needs
Demonstrate the ability to utilize regional population risk stratification information and processes to identify appropriate members for enrollment into case management for complex longitudinal care in collaboration with clinicians and other members of the PCMH health care team and Community Pathways to Health (CPH) - Population Health Analytics
Independently and proactively completes chart reviews, screening calls and full assessments related to anticipated level of care, created patient centered care plans, and documents findings using standardized approved EHR documentation tools
Perform medication reconciliation and review when appropriate
Support the provider with identification of need for cognitive assessments in the clinic
Required qualifications for this position includes:
Graduation from an accredited school of nursing
Current state of Oregon RN licensure
Washington licensure for Case Managers assigned to work in the state of Washington
BLS (Basic Life Support) certificate for Healthcare Providers - American Heart Association (AHA)
Current Oregon or Washington drivers license & reliable personal transportation
Three (3) years of Clinical experience as an RN
Working knowledge of Medicare and Medicaid criteria for skilled nursing services or home health/medical equipment services
Demonstrated ability to work cooperatively in a multi-disciplinary team and facilitation of care conferences
Preferred qualifications for this position includes:
Bachelor's Degree in Nursing
Case Manager Certification (CCM) with The Commission of Case Manager Certification
Two (2) years of Home health, skilled nursing facility and/or community health nursing
Two (2) years of Managed care experience and/or utilization management experience
Two (2) years of Care/Case Management experience
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Req ID: 317104