Case Management Manager
Tuality Healthcare - Hillsboro, OR

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case management lead- tuality healthcare
When it comes to community, everyone has a part to play. For us, it's an honor and a duty to help those near us receive the best medical care possible. That's why, since our beginnings in 1918, we've worked hard to provide quality, convenient care for our patients. Throughout our growth and expansion, we have become a strong community-governed, not for profit, healthcare system. We take pride in our excellent quality of work and all of our services provided, creating an atmosphere that benefits our staff and patients alike. At Tuality Healthcare we recognize that the foundation for providing excellent care begins with recruiting exceptional candidates and cultivating the talents of our current employees.

Summary of Duties
Responsible for oversight of the Case Management staff and daily operations of the department. Analyzes patient medical records concurrently and/or retrospectively for quality assessment, utilization review, and discharge planning criteria.Provides concurrent reviews and retrospective reviews to insurance carriers for authorization of services.Coordinates discharge plans and orders for patients leaving the hospital. Oversees and/or submits weekly catastrophic and quarterly reports and statistics for presentation to the Utilization Review Committee and Admin Team.Develop, teach and monitor orientation program for new Case Management and Social Work employees to ensure consistency.Advises TCH committees in the development and implementation of utilization, quality and cost management approaches to achieve effective performance in the health care continuum and transitions of care.

Requirements

HIRING COMPETENCIES - skills & experiences the applicant should bring to the job.
1. Education: Graduate of accredited School of Nursing, preferably with a bachelor of science in nursing, or completion of BSN or MSN within 5 years.
2. Minimum 2 years previous supervisory experience
3. License: Current license as a Registered Nurse by the Oregon State Board of Nursing required . CCM (Certified Case Manager) preferred.
4. Competent in Case Management, Utilization Review and Discharge Planning required.
5. Strong clinical nursing skills with at least 5 years hospital experience in varied clinical settings.
6. Demonstrates ethical commitment to quality assurance and confidentiality of all data and information.
7. 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.
8. Ability to develop case management care plans and solutions utilizing problem-solving skills.
9. Knowledge of community health and social service resources preferred.
10. Ability to document care in the Electronic Health Record accurately and efficiently.
11. Emulates THC dress code and Code of Conduct that incorporates presenting a good first and lasting impression by personal appearance and interpersonal skills.
12. Experience working in highly confidential settings.
13. Possesses excellent customer service, telephone skills and interpersonal communication abilities both verbal and written.
14. Familiar with computerized word processing, database and spreadsheet programs.
15. Self-directed and must be able to follow through on projects and implement ideas and programs with minimal supervision.
16. Demands creativity, flexibility and the ability to work under stress.
17. Ability to follow through on projects with attention to detail and accuracy.
18. Ability to effectively supervise others and create a welcoming environment for staff.
19. Knowledge of medical staff organizations, managed care plans, quality improvement , and utilization management required.

PHYSICAL REQUIREMENTS AND HAZARDS:
Percentage of Time Spent:

% of time

Physical Requirement

30-60%

Standing

30-60%

Sitting

30-60%

Walking

1-30%

Lifting / Carrying

Physically Demanding Tasks: Eye-strain from continual computer usage.

Tuality Healthcare - 17 months ago - save job
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