Registered Nurse - Care Coordination

To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment. Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregons standard accommodation process. Position Title: Registered Nurse Care Coordination Department Population Health Partnership Title of Manager: Care Coordination Supervisor Supervises: Non-supervisory position Employment Status: Regular Exempt Requisition ID: 21744 General Statement of Duties The Registered Nurse Care Coordination (RN CC) is responsible for clinical collaboration across the department and with members, providers and other community stakeholders. Key functions of the position include addressing OHP members exceptional care coordination needs, conducting assessments and developing care plans for OHP and/or CareOregon Advantage members meeting high risk criteria and responding to other member health care needs according to established department protocols. Key partners in this process are the member and relevant family/caregivers, the members primary care and other providers, appropriate community partners and internal operational staff. The care coordination services are evidence-based and culturally-specific. Specific Position Duties Registered Nurse Care Coordination (RN CC/ENCC): RNs working with the Exceptional Needs Care Coordination program may have their assignment changed based on member population changes and department needs. Essential Position Functions Collaborate with internal and external clinical disciplines and demonstrate a client-centered approach in work with members. Evaluate all relevant information in order to determine the physical, behavioral, social support, and medical need of the member. Assess overall risk of member physical, behavioral, social support system availability and relationship with providers and intervene as necessary . Provide culturally and linguistically appropriate ICM services to members identified as Aged, Blind, and Disabled, members with special health needs (complex, high utilization, multiple comorbidities, and/or serious behavioral health issues) and those in Long Term Care services under the States 1915(i) State Plan Amendment. Respond to requests for care coordination services for members with Special Healthcare Needs within one business day. Develop individualized plans of care for high risk members and participate in multi-disciplinary Team Meetings with all involved care team entities and member/caregiver, as appropriate, to coordinate care services members. Collaborate with hospital/facility discharge planners regarding OHP members who are discharging from hospital or SNF care to the community and in need of transitions services. Support the medical management plan provided by the members primary and specialty providers and determine follow-up needed. Collaborate with primary care and community health care providers and staff, Aging and People with Disabilities caseworkers, Oregon Health Authority Innovator Agents and Client Services Unit staff, business partners, vendors, community agencies, and other relevant parties. Provide direction to non-clinical staff as indicated. Identify suspected abuse and neglect issues and appropriately report to mandated authorities. Collaborate with internal and external referral sources. Evaluate database profiles which identify members considered high risk for medical care resource utilization, per unit protocol. Document activity as required by unit policy. Maintain working knowledge of COA and OHP benefits, including Addictions and Mental health benefits. Creatively utilize available community resources as an adjunct to health plan benefits and follow-up to determine if these are received by the member. Involve PHP or Operations Medical Director for review of member complex care needs and plans that appear to warrant medical director review. Assist members to ensure timely access to providers and services. Coordinate with providers to ensure consideration is given to member needs in treatment planning. Assist providers with coordination of services. Maintain unit compliance with the contractual and regulatory requirements. Report member complaints to the appropriate authority for investigation and follow-up, per protocol. Essential Department and Organizational Functions Serve as team leader for members with care coordination needs. Work with other CareOregon staff or departments as needed for care coordination. Forward relevant information of members requiring special consideration of benefits to appropriate Medical Director for review. Make referrals to established community programs as appropriate. Collaborate with community partners in achieving improved health status for member populations. Provide coaching and training on specific job responsibilities. Follow team, departmental, and organizational policies and procedures. Report to work as scheduled and follow attendance policies. Perform other duties and projects as assigned. Participate in quality and organizational process improvement activities and teams when requested. Maintain strict confidentiality, observing all HIPAA rules. Participate in work-related continuing education when offered or directed. Knowledge, Skills, and Abilities Required Knowledge of the Oregon Health Plan benefit package, eligibility categories, and Oregon Medical Assistance Program (MAP) rules and regulations Knowledge of Medicare parts A and B benefit packages and the Centers for Medicare and Medicaid Services (CMS) rules and regulations and community resources Knowledge of ICD, CPT, and HCPCS codes Knowledge of Addictions and Mental Health services and Programs, drug formularies and basic concepts of managed care Knowledge of culturally-specific issues, resources and strengths of the populations served Competency in the use of motivational interviewing Knowledge of program requirements for Medicare populations and OHP populations Ability to understand complex medical and behavioral health diagnostic information to assist providers and other care coordinators Ability to organize work and remain focused under stressful conditions with critical attention to detail for accuracy and timeliness Ability to collaborate with a variety of professional and technical staff maintaining a customer service orientation and function under potentially tight timelines Ability to exercise sound clinical judgment, independent analysis, critical thinking skills, and knowledge of health conditions to determine best outcomes for members Ability to establish collaborative relationships, work autonomously and effectively set priorities and work in an environment with diverse individuals and groups Ability to effectively lead a multidisciplinary team and manage multiple tasks and remain flexible in a dynamic work environment Excellent verbal and written communication and basic word processing skills Physical Skills and Abilities Required Lifting/Carrying up to 10 Pounds Pushing/Pulling up to 10 Pounds Pinching/Retrieving Small Objects Crouching/Crawling Reaching Climbing Stairs Repetitive Finger/Wrist/Elbow/ Shoulder/Neck Movement 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day Standing Walking Sitting Bending Seeing Reading Hearing Speaking Clearly 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day Cognitive and Other Skills and Abilities Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress. Education and/or Experience Position requires current unrestricted Oregon RN license. Preference will be given to qualified candidates who have experience in case management of OHP and/or Medicare members, experience with a similar population in health plan case management or managed care coordination, experience administering the Oregon Health Plan (Medicaid) and the Centers for Medicare and Medicaid Services (Medicare) benefits, experience in the use of Motivational Interviewing and certification as a certified case manager. Working Conditions Environment: This positions primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis): Inside/office Clinics/health facilities Member homes Other_____________ Travel: This position may include occasional required or optional travel outside of the workplace, in which the employees personal vehicle, local transit, or other means of transportation may be used. Equipment: General office equipment Hazards: n/a Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment Veterans are strongly encouraged to apply. Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Created: 2025-11-15