This position is responsible for providing ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs. This position is also responsible for promoting continuity of care and cost effectiveness through the integrating and functions of case management, utilization review, and discharge planning by performing the following duties.
Identifies and develops Care Plans for members enrolled in the Transition of Care (TOC), Special Needs Population (SNP) and Complex Case Management (CCM) programs.
Oversees utilization review to determine eligibility, appropriate level of care, quality of care, continuity of care, and cost effectiveness of services provided to the member.
Coordinates with local agencies, Primary Care Physicians (PCP), and community resources to identify members in need of Case Management (CM) services by reviewing health risk assessment, chronic disease, inpatient, and emergency room reports.
Develops a working relationship with the member, family, and caregivers and serves as an advocate.
Regularly attends the Interdisciplinary Care Team (ICT) meetings.
Manages the care, coordination, and discharge planning of all members enrolled in the Special Needs Program.
Develops a Care Plan through assessments of member's needs, condition, environment and medical records.
Ensures all Care Plan’s include the assessment, interventions, measurable short and long term goals, and outcomes.
Reviews health risk assessment, chronic disease, inpatient, and emergency room reports.
Provides education for both the member and their family or support system.
Coordinates with the members Primary Care Physician (PCP), specialist, and other community resources involved in care of the member.
Maintains a positive working relationship with other agencies and providers including out of area.
Maintains confidentiality and complies with HIPAA rules and regulations.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
Respectfully takes direction from manager.
RN Case Manager, RN Intensive Care Case Manager and RN Pediatric Case Manager positions available.
This position requires an Oregon Nursing license. Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification is required within one year of date of hire.
4 openings. Telecommuting is allowed.
Additional Salary Information: We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.
About Cascade Comprehensive Care, Inc.
Cascade Comprehensive Care, Inc. is a health care management company based in Klamath Falls, Oregon. Cascade Comprehensive Care (CCC) was founded in 1992 to create health care access for Klamath County residents. CCC endeavors to create and manage successful health care delivery in the community. Our company works to bring local health care providers together in order to deliver quality services efficiently and effectively.
CCC is owned by local health care providers, including primary care physicians, specialists and other health organizations.
CCC operates Klamath County’s coordinated care organization, Cascade Health Alliance, through a contract with the Oregon Health Authority. Cascade Health Alliance (CHA) serves approximately 18,000 members through the Oregon Health Plan, the state’s Medicaid plan.
CCC is a founding partner in ATRIO Health Plans and the local administrator for ATRIO in Klamath County. ATRIO Health Plans is a Medicare Advantage (MA) plan that offers Preferred Provider Organization (PPO) options as well as a Health Maintenance Organization (HMO) Special Needs Plans for Dual Eligibles.