RN Director, Nursing Case Management

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Estimated Hiring Range:

Bonus Target:

Priority will be given to candidates residing in Oregon and Southwest Washington.

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

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Essential Responsibilities

Technical/Operational Leadership

• Provides operational leadership and oversight of care coordination teams, including nursing care managers, supervisors, leads and front-line staff.
• Plans and oversees delivery of care coordination services in compliance with all local, state, and federal regulations.
• Provides consultation and oversight to nursing care managers regarding complex case management and disease management issues.
• Consults with the Vice President of Care Coordination and the Medicare Medical Director, Model of Care Director on medical issues as needed and administrative responsibilities including QAPI, Model of Care and compliance.
• In consultation with Medicare leadership, helps to define strategic approach to case management, disease management and population health interventions.
• Safeguards the ICT process of collaboration, providing leadership and facilitating problem-solving as needed.
• Ensures systems are in place for the maintenance of medical records, assuring accuracy, completeness and compliance with regulations and standards including HIPAA.
• Develops and/or approves; oversees development and dissemination of procedures.
• Supports the Quality Assurance Process Improvement (QAPI) program and Model of Care (MOC), to include:
  • Review data regarding patient services and outcomes according to QAPI and MOC plan
  • Review, present, and submit data compiled by teams regarding productivity and quality standards
  • Set and monitor targets with the team including performance improvement projects, productivity, quality of care and documentation
• Provides clinical leadership in the development and review of clinical protocols and processes that support appropriate referral and consistent quality care coordination.
• Provides clinical/quality consult for managers and team members.
• Plans and implements staff education programs, guiding and documenting staff participation.
• Strategically engages in activities to enhance the team’s capabilities such as improving care coordination process with partner organizations, developing and nurturing clinicians’ skills, resolving process bottlenecks, creating new tools and processes, and ensuring compliance.

Strategic/Operational Planning

• Leads the development and implementation of departmental vision, goals, and strategic plans.
• Provides input into the strategic plans of the organization.
• Develops annual program goals that align with organizational strategic goals in collaboration with the Vice President, Care Coordination and Medicare Medical Director.
• Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.
• Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

• Provides input and participates in the department budgeting process annually.
• Recommends budgets in alignment with short and long-term plans.
• Manages resources to ensure priorities are accomplished.
• Recommends changes which result in more effective use of resources and cost containment.
• Ensures approval for budget variances as required.
• Approves resource allocations within budget, including people, finances, and timelines; makes decisions on exceptions.

Relationship Management

• Leads effective communication system for work group(s), ensuring a collaborative culture.
• Builds and ensures effective relationships across internal teams and external organizations for current or future integration.
• Partners with internal leaders and managers in identifying improvement plans and processes.
• Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.

Employee Supervision

• Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
• Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
• Identifies department priorities; ensures employees have information and resources to meet job expectations.
• Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
• Manages, coaches, motivates, and guides employees; promotes employee development.
• Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
• Ensures team adheres to department and organizational standards, policies, and procedures.
• Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
• Performs supervisory tasks in collaboration with Human Resources as needed.

Experience and/or Education

Required

• Minimum 8 years’ related experience, including clinical care, health care coordination and/or health care operations
• Bachelor of Science in Nursing degree
• Current unencumbered RN license in the State of Oregon

Preferred

Minimum 4 years’ experience in a supervisory position

Minimum 5 years’ experience in managed care or the health insurance industry

Masters of Science in Nursing

RN Case Management Certification

Knowledge, Skills and Abilities Required

Knowledge

Strong knowledge of case management/care coordination needs for diverse populations

Strong knowledge of Federal, State and Local regulations, and HIPAA privacy rules and regulations

Proficient knowledge of the Epic system

Skills and Abilities

Superior care management, team management, organizational and problem-solving skills

Effective strategic planning, policy development and process improvement skills

Excellent time management, organizational, and communication skills

Advanced computer skills and a working knowledge of MS Office, Outlook, and the internet

Ability to effectively lead data collection, analysis, and management

Ability to work with high-energy, be persistent, assertive, data driven and focused

Proactive and action oriented; ability to drive performance and be persistent in accomplishing difficult tasks

Work with an open leadership style and actively seek out and support collaborative thinking and problem solving with others inside and outside the organization; approaches his/her work as an interconnected system

Proficient in developing KPI metrics reporting for clinical operations

Ability to influence others without direct authority and negotiate favorable outcomes

Ability to take complex ideas and processes and communicate them in a clear and concise manner

Ability to balance strategic and operational priorities, and proactively identify and resolve operational barriers and issues

Ability to direct teams of clinical and non-clinical operations support staff engaged in diverse activities

Team management skills, including hiring, goal setting, coaching, performance management, and development

Ability to create and develop strategic partnerships with multiple stakeholders both internally and externally

Ability to work with internal and external stakeholders regarding technology, process, and regulatory issues

Ability to work effectively with diverse individuals and groups

Ability to learn, focus, understand, and evaluate information and determine appropriate actions

Ability to accept direction and feedback, as well as tolerate and manage stress

Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure

Member/Patient Facing: ☐ No ☒ Telephonic ☐ In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Hybrid-Office 2 days/week

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

About CareOregon

CareOregon is a nonprofit, mission-driven health plan, focused on providing care to low-income Oregonians. The CareOregon family includes Columbia Pacific CCO, Jackson Care Connect, and our work as part of Health Share of Oregon.

Our mission is to inspire and partner to create quality and equity in individual and community health. Our vision is healthy communities for all individuals, regardless of income or social factors.

Driven By Our Purpose

Making Healthcare Work for Absolutely Everyone.

Equal Employment Opportunity

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Veterans

CareOregon greatly encourages military veterans to apply. CareOregon is a major sponsor of the annual Portland Veterans Stand Down and hiring fair.