21 Nov
Clinical Case Manager - Proactive Outreach Team
Oregon, Portland

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.


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