At CareOregon, we’re looking for professional people with energy, drive and persistence – people who are ready to make a change, because we’re better together.
Assists with the creation and implementation of utilization management procedures and supporting activities. Performs Transplant Case Management for both OHP and Medicare members. May perform the tasks of the Care Management RN staff during times of coverage needs or reassignment of work. This position ensures staff is performing at required competency and production levels and for implementing new processes and procedures that support Case Management programmatic goals and objectives in support of CareOregon’s mission and vision.
Knowledge, Skills and Abilities Required
• Knowledge of utilization management practice principles and industry standard criteria
• Knowledge of Interqual and Milliman/Robertson review criteria
• Knowledge of Oregon Health Plan (OHP) benefit package including rules and regulations that pertain to health plan operations
• Knowledge of Medicare A and B benefits and regulations governing Medicare Advantage plans
• Knowledge of principles of managed care and utilization management
• Ability to work with the department, stakeholders or customers to effectively resolve issues
• Knowledge of ICD-9, CPT, HCPCS coding
• Ability to use critical thinking skills in problem solving
• Ability to manage multiple tasks and to remain flexible in a dynamic work environment
• Ability to function autonomously and to effectively set priorities
• Ability to present a positive and professional image
• Ability to develop and implement processes and procedures
• Ability to provide effective leadership and supervision to groups of people
• Ability to read, write and verbally communicate effectively
• Excellent customer service skills
• Ability to work in an environment with diverse individuals and groups
• Ability to use basic word processing, spreadsheet and database programs and the ability to learn more complex programs
Education and/or Experience
Current unrestricted Oregon Registered Nurse’s license; minimum of two (2) years utilization management experience in all functions (authorizations, concurrent review, and referrals) and one (1) year of supervisory experience is required. Preference may be given to qualified candidates who have UM experience and detailed knowledge of the Oregon Health Plan (OHP) benefit and the Oregon Medical Assistance Programs (MAP) and the Centers for Medicare and Medicaid Services (CMS) rules and regulations.
For complete job description and to apply, visit us online at http://www.careoregon.org/AboutUs/Careers/JobOpenings. Position may close at any time. EEO