Supervisor,Care Coordinator Job Portland area,Oregon USA,Nursing

About Moda

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re 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. Let’s be better together.

Position Summary

This is a FT hybrid position based in Portland, Oregon. Leads and supervises RN Care Coordination team. Oversees commercial and individual plan medical utilization management program by managing workflow, training staff, auditing quality, and reporting cost savings, productivity, and other performance measures.

Pay Range

$86,486.08 - $ annually (depending on experience)
* 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.

Benefits

Medical, Dental, Vision, Pharmacy, Life, & Disability
401K
- Matching
FSA
Employee Assistance Program
PTO and Company Paid Holidays

Required Skills, Experience & Education

Requires current unrestricted Oregon RN license, and degree from accredited school of nursing

Supervisory, management or lead experience in a medical and/or health insurance setting is required.

Minimum 3 years of Utilization Management, Care Coordination or Case Management experience with health plan or similar organization.

Analytical and detail oriented, with demonstrated initiative, problem solving, organizational, and critical thinking skills.

Proficiency with Microsoft Word and Excel is required, with typing speed of 35 wpm or better.

Excellent verbal, written and interpersonal communication skills.

Demonstrated skill in speaking and presenting to groups.

Ability to work well under pressure.

Ability to maintain confidentiality and project a professional business image.

Ability to come in to work on time and daily.

Primary Functions

Ensures department standards and goals are achieved through training, delegating, and coaching of staff.

Develops, maintains, and reports performance measures for work team.

Monitors through training and auditing to assure compliance with NCQA and CMS standards.

Supervises clinical staff providing daily work direction, vacation scheduling, monitoring attendance, giving performance reviews, hiring, and training new employees.

Determines and implements an organized and systematic management plan for handling such cases.

Develops programs with acute care coordination component.

Understands the care coordination environment and facilitates integrating chronic disease programs into day-to-day workflow.

Assists Manager with development and implementation of utilization management and care coordination programs

Participates in internal and external audits

Ensures comprehensive communication and integration with all medical management and case management programs and functions.

Monitors and reports on program outcomes, value, performance, and quality, ensuring accuracy and timeliness.

Establishes contacts with health care vendors and coordinates with providers when necessary to achieve case management and care coordination objectives.

Establishes effective, collaborative working relationships with peers within department and with all other departments.

Develops and implements staff development & education curricula.

Facilitates and coordinates weekly…

Supervisor, Care Coordinator