RN, Integrated Community Care Manager at Portland, OR (Downtown) – Portland, Oregon

The Integrated Community Care Manager-RN provides one-site (face-to-face) and telephonic outreach, behavioral health, disease and/or care management, care coordination, care integration, care transition, education, support and navigation to OHSU Health Services Members with the goal of supporting healthy life choices and to reduce long term effects of chronic illness. The Integrated Community Care Manager-RN performs other clinically based activities to assist in the coordination and integration of care between the Member, his/her provider(s), health care facilities, health and behavioral clinics, and community-based healthcare organizations and agencies. The Integrated Community Care Manager-RN enhances the quality of Member management by promoting continuity of care and cost effectiveness through whole person care management, care integration, and care coordination across the continuum of health care services.

• Clinical assessment skills, consistent with state licensure scope of practice.
• Ability to assess patient health status, consistent with state licensure scope of practice requirements.
• Able to prioritize and target interventions, consistent with state licensure scope of practice requirements.
• Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.
• Organizational skills with the ability to handle multiple tasks and/or projects at any one time.
• Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from different departments and/or agencies within and outside OHSU and OHSU Health Services.
• Knowledge and experience working within Epic as the electronic medical record.
• Knowledge of Medicare and Medicaid.
• Knowledge of adult learning and behavior change principles.
• Knowledge of community-based resources.
• Demonstrated skills in motivational and health coaching, patient advocacy, health promotion, disease prevention, patient education and resource management.
• Demonstrates knowledge of NQCA and Case Management guidelines.
• Provides care management services appropriate to the age of the member served – neonate, infant, pediatric, adolescent, adult and geriatric patients based on the principles of growth and development and life stages

• BSN Graduates: Baccalaureate Degree in Nursing from a program accredited by Commission of Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN) or Commission for Nursing Education Accreditation (CNEA) 30 days before start date.
• ADN Graduates: Associate Degree in Nursing from an accredited program 30 days before the start date.
• Associate degree Nurses required to enroll in BSN program within 3 years of hire and complete within 5 years of hire
• Current, unencumbered Oregon State Registered Nurse License
• BLS at time of hire and must be issued by the American Heart Association (AHA)
• BLS must not expire during orientation
• Must be able to perform the essential functions of the position with or without accommodation
• Minimum three (3) years of clinical nursing experience.
• Minimum two (2) years of Case/Care Management experience.
• Current unrestricted Oregon nursing license.
• Attainment of Professional certification as a Case Manager within 24 months of hire.