Performs advanced case management and intervention for high risk members of the Tuality Health Alliance by using a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services to meet an individual's health needs using communication and available resources to promote quality and, cost effective outcomes. Provides support for primary care practices to function as patient-centered medical homes through direct member support, process improvement, and provision of linkage to community resources. Analyzes patient medical records concurrently and/or retrospectively for utilization review, quality assessment, risk management and discharge planning criteria. Provides leadership for the development and implementation of quality improvement activities. Provides back-up for Utilization Review Nurse as necessary.
a) License: Current licensure as a RN from the Oregon State Board of Nursing required.
b) Minimum of 2 years experience in Utilization Review, Discharge Planning, and Case Management or equivalent.
c) Clinical skills with at least five years experience in varied clinical settings or equivalent.
d) Knowledge of community health and social service resources.
e) Ability to develop case management care plans and solutions utilizing problem-solving skills.
f) Knowledge of medical staff organizations, managed care plans, quality, and utilization management preferred .
g) Emulates THC dress code and Code of Conduct that incorporates presenting a good first and lasting impression by personal appearance and interpersonal skills.
h) Demonstrates excellent customer service skills.
i) Advanced communication and interpersonal skills that utilizes consideration body language, filters, listening, paraphrasing, and questions with customers of diverse ethnic and cultural backgrounds.
*This also includes the skills to obtain and interpret information appropriate to patients' needs and age as required for assessment, range of treatment and patient care.
j) Self directed and must be able to follow through on projects with attention to detail and implement ideas and programs with minimal supervision.
k) Ability to implement ideas and programs required.
l) Familiar with computerized word processing, database and spreadsheet programs.
m) Ability to write clear and legible clinical notes.
n) Composes written material from an idea or philosophy.
o) Experience working in highly confidential settings.
p) Possesses excellent telephone skills and interpersonal communication abilities both verbal and written.
q) Demands creativity, flexibility and the ability to work under stress.
PHYSICAL REQUIREMENTS AND HAZARDS:
Percentage of Time Spent:
a. 30-60% Standing b. 30-60% Sitting
c. 30-60% Walking d. 1-30 % Lifting/Carrying
Physically Demanding Tasks: Lifting and carrying of large photocopy projects, medical records or lap top computers sometimes exceeding 10 pounds
At Tuality Healthcare, an OHSU Partner, it's an honor and a privilege to serve those near us. That's why since our beginnings in 1918, and as we expand our strong network of services through our clinical affiliation with OHSU, we continue to be committed to providing the best health care possible and a valued community partner. Our affiliation with OHSU brings the advanced medical resources of Oregon’s only academic health center, which allows local providers to receive guidance from some of the country’s top specialists and pass that expertise on to Tuality patients where they can be cared for in their community.
Tuality’s many awards showcase our position as one of the Portland metro area’s premier healthcare providers, including 5th straight year in Top 10 Healthiest Employers in Oregon from The Portland Business Journal, Tuality’s 6th straight Gold Plus Award from the American Heart Association, and 2016 #1 Nationwide Best Hospital IT Department to work for according to Healthcare IT News.
Here at Tuality our employees care about making a difference. In fact, they care so much that in our most recent employee satisfaction survey we had an 80% participation rate! Tuality is truly unique because of the relationships we build and as individuals we are seen and heard. Come be part of our team, and let your voice be heard!