Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence Health Plan is calling a Clinical Program Coordinator RN who will: - Support the commercial insurance based line of business for cases including but not limited to: Maternity, Pediatrics, Transplant, Pain Management - Provide care coordination, case management and care management services to Providence Health Plans (PHP) members - Case management services include: triage and referral, transition of care planning, acute and catastrophic case management - Care management services include: nurse education, care coordination and general assistance with managing day to day functional needs; assisting with the management of member health plan benefits and offering assistance finding alternative services when benefits are exhausted - Work within the health plan framework of managing medical expenses - Work to improve access and quality care to our members Providence Health Plan welcomes 100% remote work for applicants who reside in the following areas: - Oregon Please note the following important details regarding this role: - This posting is for multiple openings of a Clinical Care Coordinator RN - This position is affiliated with Providence Health Plan and will be tied to a location and compensation range in Beaverton, Oregon - This position requires for you to have a current home address in either the State of Oregon or Washington - Work Shift: Monday - Friday - Work Hours: 8am - 5pm Required qualifications for this position include: - 5+ years of clinical nursing experience - Experience working with physicians in the collaboration and management of patient care - RN License: State of Oregon Preferred qualifications for this position include: - Bachelor's Degree in Nursing or Health Education - Within six months of hire date: Current unencumbered Registered Nurse License in Washington State - Case Management Experience (EX. Triage and Referral, Transition of Care Planning, Discharge Planning, Coordination of Outpatient Care) - Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) - Experience working in a health plan, medical insurance plan or another similar work environment - Current nursing experience in the following areas: chronic pain management, cardiology, pediatrics, maternity Why Join Providence Health Plan? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment 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. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Our culture and people are what set us apart from other post-acute care providers. We’re dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY. LOCATION: Fully Remote with provided equipment SCHEDULE: 5 days a week 8:15am - 5:00pm, Monday - Friday with a rotating weekend commitment SCHEDULE: Annual Compensation of $70,000 SUMMARY: The RN Care Manager is responsible for the development, oversight and continuity of the patient plan of care, serving as the liaison for collaboration and communication with the field staff. The RN Care Manager will participate in the interdisciplinary team meetings to ensure tight collaboration and appropriate care planning and delivery. This role will manage health care costs by influencing patient care decisions for value-based care delivery, visit type, frequency and calendar plotting cadence based on medical necessity review and utilization management guidelines. The RN Care Manager will assess for real time patient clinical, functional and behavioral health status to ensure rapid follow up, and allocation of services. The RN Care Manager will work alongside branch operations to ensure a holistic approach to patient care. The RN Care Manager will be integral in contributing to the development of new and / or revised work processes, policies and procedures relating to the ASHN Care Management Program. MAJOR AREAS OF RESONSBILITITY: - Plan of Care (POC) review and revision to reflect accuracy and regulatory standards - Recertification/Discharge review and recommendation - Utilization/Calendar Management - Adhere to Utilization Management Guidelines - Participate in Interdisciplinary Team Meetings and Agency Townhall Meetings - Seek opportunities to contain cost - Review Charts to monitor compliance with regulatory and governmental regulations - Meets productivity standards and workflow expectations - Functions as a resource for clinicians, agency staff, and internal staff - Collaborates with clinicians as necessary for documentation clarification or educational opportunities - Attends in-service trainings and mandatory agency meetings - Stays current with CMS guidelines and Oasis Guidelines - Read and adhere to all Agency Policies and Procedures and follow Employee Handbook Guidelines - Completes and submits all required documentation within specified company requirements - Other duties as assigned QUALIFICATIONS: - Registered Nurse licensure required - Two years home care field experience preferred - One-year clinical review preferred - Two years case management and/or utilization management experience preferred - Demonstrates exceptional collaboration skills - Self-starter and innovative problem solver - Proficiency in HCHB preferred - Knowledge of Medicare, Medicaid and all State/Federal guidelines for compliance of patient clinical care - Strong clinical acumen to thoroughly understand the patient’s health and functional status and foster effective communication - Able to create positive impressions and communicate effectively with a variety of people and personalities - Is an active listener and demonstrates ability to engage care team in the patient plan of care - Must project a professional image during virtual communication - Ability to set up work systems and engage in flexible problem-solving behavior - Observant and detail oriented - Proficient in Microsoft Office including Excel, Outlook, Power Point and Word #INDASHN3 We’ll help you put your passion for patient care to work. Apply today! This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. We are an Equal Opportunity Employer.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Responsible for health care management and coordination within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Supports Transitions of Care (TOC) to ensure timely access and coordination of follow up care, adherence to discharge plans and member education to support improved health outcomes. Coordinates and monitors Alignment Health member’s progress and services to ensure consistent cost-effective care that complies with Alignment policy and all state and federal regulations and guidelines. Performs duties mostly telephonically General Duties/Responsibilities (May include but are not limited to): - Supports inpatient program engagement for Alignment members currently inpatient in an acute or skilled nursing facility setting. - Manages Transitions of Care (TOC) for members moving from inpatient, SNF, and emergency services to lower level of care facilities or home, in accordance with established workflows. - Manages TOC activities including post-discharge follow up appointment scheduling and monitoring for kept appointments - Ensures member access to services appropriate to their health needs. - Identifies, assesses, and manages high risk/complex members per established criteria and health risk status. - Develops, monitors, and evaluates the effectiveness of the care management plans and modifies, as necessary to support improved health outcomes. - Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans. - Assists in problem solving with providers, claims or service issues. - Measures the effectiveness of interventions to determine case management outcomes. - Counsels and engages in personal discussions with patients and their families on available care options. Helps them to determine their appropriate and preferred course of action. Job Requirements: - Required: 3 years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background Preferred: Medicare Advantage Health plan experience Education/Licensure: Required: - Active, valid, and unrestricted Registered Nursing (RN) license in California - Willing to obtain licensure in other designated states within the first 6 months of employment (licensure fees reimbursed by the company) Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. - The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $79,697.00 - $119,545.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Put your talents to work at PCM! Whether you work in our Home Care, Clinical Research, Impairments, or Catastrophic Care division, you will support our mission to deliver care and other services that enhance the quality of life of our clients. Be a part of our dynamic client-focused team and make a difference in your career! Performs advisory activities to assist a Specialized Services Physician and Clinical Administrator with all the tasks necessary to write medical opinion letters for PCM Home Care clients wishing to add conditions to their white card. QUALIFICATIONS: - Knowledge of the EEOICPA program is strongly preferred - Demonstrates strong verbal, written and interpersonal communication skills. - Strong computer skills. - Speaks, reads, writes, and comprehends English. - Demonstrates time management, organizational skills, and ability to function with minimal direction. - Diligently maintains claimant contact records in Salesforce - Utilize strong phone skills – this role requires extensive time on the phone, but is not considered a Call Center position - Provide exceptional customer service to claimants - Build strong relationships with team members, physicians, and Case Managers. ESSENTIAL FUNCTIONS/AREAS OF ACCOUNTABILITY - Liaising with PCM’s Clinical Operations and Home Care clients regarding prospective new conditions that can potentially be added to a client’s white card - Provide clients with forms needed to assist in collecting records on their behalf as well as filing claims, secure return of signed forms, and follow up as necessary - Request records from treating physicians and providers in support of the claim - Receive and organize medical records - Answer claimant questions regarding the DOL - processes and EEOICPA program and benefits - Work directly with clients and Case Managers to guide them through the DOL process - Follow up with claimants at each step of their DOL authorization process to gauge progress and offer additional guidance - Document all steps in Salesforce and update as applicable - Additional job duties as assigned. The typical base pay range for this role is USD $42,640 - $60,320 per year.Individual base pay depends on various factors, in addition to primary work location, complexity and responsibility of role, job duties/requirements, and relevant experience, skills and other market-based factors. Available Benefits Include - Medical - Dental - Vision - 401(k) - Company Paid Short Term Disability - Flexible Spending Account (FSA) - Health Savings Account (HSA) - Paid Time Off - Voluntary Benefits Please contact Mark Rainey II at or at Mark.Rainey@procasemanagement.com today to learn more about our opportunities where you can make a difference in your own career! Professional Case Management is an Equal Opportunity Employer.