Responsible for ensuring the delivery of quality care to the enrollees in accordance with individual needs, physician orders and standards of care, as represented through Medical Management and State and Federal policies. Works collaboratively with Case Managers in order to screen and identify candidates for THA Case Management services. Authorizes services per plan guidelines, develops individualized case management plans including follow up, provides and reinforces patient education and assists members in forming solutions to health problems consistent with the plan of care. Assists the Case Management team with written communications, collecting health history, conducting research, reporting member feedback, record keeping, issuing denials and other support to promote efficiency and excellent customer service. Promotes and provides member/provider outreach to ensure quality of care and access to our members. Participates as an active member of the QI team in developing and implementing quality improvement programs to improve care and access to our members.
a) Education: Bachelor’s degree in healthcare related field preferred
b) Bilingual Spanish and English preferred.
c) Minimum of 2 years of current and relevant experience in a health care setting.
d) Discharge planning, utilization review, case management or healthcare insurance experience preferred.
e) Current pharmacological knowledge preferred.
f) Functions effectively as part of a team.
g) Uses a problem solving process to make decisions related to patient care.
h) Motivational interviewing, counseling and direct patient contact experience strongly preferred.
i) Demonstrates effective written communication skills utilizing appropriate grammar and spelling.
j) Manages multiple tasks, priorities, deadlines and interruptions successfully.
k) Utilizes effective conflict resolution skills.
l) Demonstrates proper appearance and personal conduct for the employee's particular job.
m) Uses effective communication skills taking into consideration body language, filters, listening, paraphrasing and questions with customers of diverse ethnic and cultural backgrounds.
n) Demonstrates organizational skills.
o) Demonstrates good customer service skills.
p) Excel/PowerPoint experience plus data collection and analysis skills preferred
q) Comfort in public speaking and leading teams desired
s) Bilingual skills a plus.
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!