Monster
 
 
 
 

Job Summary

Company
Physician Health Partners
Location
Portland, OR
Industries
Healthcare Services
Job Type
Full Time
Employee
Years of Experience
2+ to 5 Years
Education Level
Bachelor's Degree
Career Level
Experienced (Non-Manager)

Facility Care Manager/Utilization Management Nurse

About the Job

GENERAL SUMMARY OF DUTIES:  Review appropriate utilization of medical services, quality of care, risk management and provides intervention for care management. Assist the working committees in utilization and care management.


 

















  • Review concurrent and retrospective inpatient and/or subacute admissions for utilization based on Milliman Care Guidelines criteria, quality assurance, risk management, and discharge planning needs.



  • Develop and maintain a good working relationship with the healthcare team, to include correctional institution personnel.



  • Seek appropriate medical and/or staff intervention in a timely manner to assure problem prevention and resolution.



  • Assess patient’s medical and psychosocial needs to develop, communicate and implement a comprehensive plan of care in collaboration with the healthcare team.



  • Document pre-authorizations, concurrent and retrospective reviews, care management, discharge plan in appropriate care management system to track variance and quality indicators.

 


OTHERS DUTIES/RESPONSIBILITIES:


 










  • Participate in Medical Director conference calls.



  • Participate in weekend on-call schedule rotation as needed.




 


EDUCATION:




  • Graduate of accredited school of nursing with BSN (may be waived for individual who has an RN, SW degree or diploma associate degree in nursing and demonstrates experience in quality assurance UR or discharge planning).


     


    EXPERIENCE:




    • Three (3) to five (5) years clinical nursing experience.

      


    REQUIREMENTS: 


     










    • Must have a valid driver’s license and reliable transportation.



    • 50% travel weekly to hospital facilities and correctional institutions including the Portland area, Northern Oregon, Richland Washington and Eastern Oregon i.e. Ontario, OR.

     


    KNOWLEDGE: 


     














    • Knowledge of care management.



    • Knowledge of community resources/agencies.



    • Knowledge of NCQA, QA, Medicare/Medicaid guidelines.



    • Knowledge of program and workflow development, process improvement and implementation procedures.

      


    ABILITIES: 


     
















    • Able to perform basic to intermediate level of competence with various computer software applications including MS Outlook, Word, Excel, Access and Power Point.



    • Able to effectively communicate with internal staff and external customers.



    • Able to solve resource issues in a creative, positive manner to improve clinical outcomes of patients.



    • Able to work with the outpatient care management team members to most effectively manage members. 



    • Able to participate in program development in order to identify appropriate goals of program.
     
     

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    Contact Information

    Physician Health Partners

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