Providence Clinical Case Manager - Proactive Outreach Team in Portland, Oregon
Providence is calling a Clinical Case Manager (LCSW) - Utilization Review Quality Management (1.0 FTE, Days) to Providence Medical Group Hillsboro in Hillsboro, OR.
We are seeking a Clinical Case Manager - Utilization Review Quality Management that will provide case management and care coordination services for at-risk patients, including patients with complex medical and psychosocial issues. Population-based disease management approaches and application of clinical protocols are integral to the program. This position is a core member of the patient centered medical home teams led by the physician/provider. The goals of case management are to assure a systematic approach to the coordination of health services for patients along the care continuum in order to improve the patient experience, contain health expenditures and improve quality. Clinical Case Managers assist providers in effectively identifying needs and coordinating access to appropriate care and services in an effort to improve or maintain the patients functional status and independence.
In this position you will have the following responsibilities:
Use a systematic process and clinical skills to assess, plan, implement and evaluate an individual plan of care for a patient that spans the continuum of care. The plan of care is developed in conjunction with the Primary Care Provider, the patients and the patients family or caregiver(s)
Use principles of utilization management in the decision-making process to assure both quality and cost-effectiveness
Consider alternatives to requested care. Acts as a patient advocate to assure that needed health services are provided in a timely manner. Identifies, researches and/or refers potential quality of care issues
Monitor and reassesses the plan of care to ensure that quality, quantity and goal achievement are appropriate and cost-effective
Demonstrate positive interactions with patients, physicians and staff so that productivity and coordination of services are maximized
Be actively supports continuous quality improvement and population disease management activities. Participates in clinical protocol and guideline development
Maintain, update and improve clinical expertise and care management skills
Provide appropriate education for patient, family and staff regarding community support systems
Demonstrate the ability to utilize regional population risk stratification information and processes to identify appropriate members for enrollment into case management for complex longitudinal care in collaboration with clinicians and other members of the PCMH health care team
Independently and proactively complete the chart reviews, screening calls and full assessments related to anticipated level of care and documents findings using standardized approved EHR documentation tools
Required qualification in this position includes:
Master's Degree in Social Work; from a school of social work accredited by the Council on Social Work education
Licensed Clinical Social Worker (LCSW) licensure
Current Oregon or Washington drivers license
Three (3) years Clinical Experience
Working knowledge Medicare criteria for skilled nursing services or home health/medical equipment services
Demonstrated ability to work cooperatively in a multi-disciplinary team
Preferred qualification in this position includes:
Current recognition by a national professional organization in case management
Home health, skilled nursing facility, or clinical social work experience
One (1) year Managed care experience and/or utilization management experience
Will Consider candidates with Temporary CSWA license -or- proof of CSWA initiated within six months of hire. Documentation of an approved supervision plan from the Oregon Board
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.
For information on our comprehensive range of benefits, visit:
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.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. 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.
Job Category: Social Work
Req ID: 268380