Providence Health & Services Clinical Reviewer in Beaverton, Oregon

Description:

Providence is calling a Clinical Reviewer to Providence Health Plan in Beaverton, OR.

In this position, you will:

  • Be accountable for utilization management activities including evaluation of appropriateness and medical justification of health services for MCO eligibles.

  • Focus on researching, developing, and communicating implementation of Medical Policies, including facilitating Medical Policy Committee work.

  • Be responsible for providing medical treatment reviews, case management, and treatment interventions that promote cost effective medical care and early return to work in workers’ compensation cases.

  • Identify and coordinate opportunities for Continuous Quality Improvement projects as well as provider profiling, benchmarking, and provider education.

Qualifications:

Required qualifications for this position include:

  • Graduate from an accredited School of Nursing

  • Current state license or registration in good standing

  • Strong clinical background in orthopedics, neurology and rehabilitation.

  • 5 years of clinical experience

  • 2 years of utilization review or quality assurance experience

  • Documented experience as team or project leader

  • Experience in medical literature search and analysis

  • Experience in provider profiling and data analysis

  • Experience in personal computer applications, database management, spread sheets, and word processing

Preferred qualifications for this position include:

  • Bachelor of Science Degree in Nursing

  • Masters in nursing

  • 2 years in medical case management

  • 2 years of experience in managed care or in workers’ compensation insurance

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Health Plans

Location: Oregon-Beaverton

Req ID: 184623