Post job

Utilization review nurse jobs in Oregon

- 208 jobs
  • Utilization Management Nurse

    Centerwell

    Utilization review nurse job in Salem, OR

    **Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Use your skills to make an impact** **Required Qualifications** + Active unrestricted RN license with the ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers **Preferred Qualifications** + Education: BSN or bachelor's degree in a related field + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Alert** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Interview Format - HireVue** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Benefits** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2025 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
    $71.1k-97.8k yearly Easy Apply 42d ago
  • Utilization Review Nurse

    Umpqua Health 3.8company rating

    Utilization review nurse job in Roseburg, OR

    JOB TITLEUtilization Review NurseREPORTS TOUtilization Review, ManagerSTATUSFT, ExemptWAGE RANGEGrade 20 (2024) DEPARTMENTUtilization ManagementWORK LOCATIONRemote (occasional travel as required) The Utilization Management Nurse is responsible for evaluating clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role applies professional nursing judgment to conduct prior authorization reviews, facilitate care coordination, and support transitions across care settings. The nurse ensures compliance with Oregon Health Plan (OHP), Medicare, and applicable regulatory guidelines, while a assuring member access to appropriate services. Through collaboration with interdisciplinary teams and community providers, the Utilization Management Nurse promotes integrated, high-quality care and contributes to continuous improvement in utilization management processes. ESSENTIAL JOB RESPONSIBILITIES Performing clinical assessments of various medical service requests to determine medical necessity, appropriateness, and alignment with evidence-based guidelines and benefit coverage. Conduct prior authorization and HRS flex reviews, applying nursing judgment to ensure timely, cost-effective, and high-quality care delivery. Identify and escalate complex or non-standard cases to Medical Directors; request and evaluate additional clinical documentation as needed. Collaborate with care coordinators, discharge planners, and interdisciplinary teams to support integrated care and safe transitions across care settings. Maintain up-to-date knowledge of Oregon Health Plan (OHP), Medicare, and applicable regulatory frameworks (OAR, ORS, CFR, CMS, DMAP). Serve as a clinical liaison with internal departments (e.g., Third-Party Recovery, Customer Care) to resolve eligibility, coordination of benefits, and stop-loss concerns. Ensuring access to appropriate services in the least restrictive setting, while supporting continuity and quality of care. Participate in discharge planning for members transitioning from acute, long-term, or residential care to community-based services, ensuring holistic support for physical and behavioral health needs. Conduct departmental audits and contribute to quality improvement initiatives by identifying trends and recommending process enhancements. Provide training and mentorship to new and cross-functional staff on clinical workflows and UM protocols. Build and maintain collaborative relationships with community providers and service organizations to support member care plans. Ensure compliance with organizational policies, clinical standards, and all applicable federal and state regulations. Conduct work independently and in collaboration with the Utilization Management (UM) team to ensure accurate and appropriate determinations. Perform other nursing-related duties as assigned. CHALLENGES Working with a variety of personalities, maintaining a consistent and fair communication style. Satisfying the needs of a fast paced and challenging company. QUALIFICATIONSMinimum Qualifications Licensure: Active, unrestricted Registered Nurse (RN), BSN (Bachelor of Science in Nursing, MSN (Master of Science in Nursing) license in the state of Oregon or a compact state. Education: Graduation from an accredited nursing program. Experience: Minimum of five (5) years of direct patient care experience in a clinical setting, such as a medical office, hospital, or long-term care facility. Core Competencies & Skills Clinical Nursing Expertise: Deep understanding of medical terminology, diagnoses, procedures, and care modalities. Experienced in interpreting clinical documentation and applying nursing knowledge to support utilization review and care decisions. Utilization Management: Proficient in InterQual criteria, UM software, and evidence-based guidelines. Skilled in reviewing requests for medical services and ensuring appropriate use of resources. Regulatory Compliance: Strong working knowledge of NCQA standards, Oregon Health Plan (OHP), and Coordinated Care Organization (CCO) regulations, including OAR, ORS, CFR, CMS, DMAP, and the Prioritized List of Health Services. Medical Coding & Insurance: Familiar with ICD and CPT codes, health insurance processes, and state-mandated benefits. Technology & Documentation: Proficient in Microsoft Office (Word, Excel, Outlook), EHR systems, and managed care platforms. Accurate typing at 45+ WPM. Communication & Collaboration: Excellent interpersonal, written, and verbal communication skills. Builds strong relationships with providers, community services, and internal teams. Organization & Problem Solving: Highly organized and detail-oriented. Capable of managing multiple priorities, analyzing complex situations, and developing effective solutions. Ethical Standards: Maintains compliance with federal healthcare program requirements. No suspension, exclusion, or debarment from Medicare/Medicaid. Preferred Qualifications Two (2) years of utilization review or case management experience in a managed care organization or commercial insurance. Oregon residency and Oregon nursing license. Proficient in electronic systems for data entry and retrieval. Strong critical thinking, time management, and organizational skills to meet goals and deadlines. Demonstrated ability to work independently and collaboratively in fast-paced environments. Committed to continuous learning and expanding responsibilities. Knowledgeable in contractual benefits and alternative coverage options. Maintains patient confidentiality and secure health record practices. Current clinical certification and up-to-date knowledge base. Capable of conducting quality improvement audits and reporting findings. Effective in managing multiple priorities with attention to detail and accuracy. Experience working on diverse teams and considering equity impacts in decision-making. Bilingual capabilities or translation experience is a plus. PHYSICAL DEMANDS & WORK CONDITIONS A typical office environment requires standing, sitting, walking, bending, and lifting up to 25 plus pounds. Ability to travel and drive to in-person meetings or be on-site as required. May be exposed to patient and environment conditions such as unpleasant sights, smells and contagious diseases (clinic only). EQUAL EMPLOYMENT OPPORTUNITYUH is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. UH makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, read through our EEO Policy. ACKNOWLEDGEMENTI have reviewed the attached as outlined above and understand that I am responsible for all duties as outlined and other tasks as may be assigned. I understand that if I need accommodation to perform the essential functions of my job that I must contact my supervisor or Human Resources as soon as possible to begin an interactive process.Note: This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. EMPLOYEE SIGNATUREDATE About Umpqua Health At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health. Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law. Powered by JazzHR H8CdP55VL3
    $79k-94k yearly est. 28d ago
  • Drug Utilization Review Pharmacist

    Pharmacy Careers 4.3company rating

    Utilization review nurse job in Portland, OR

    Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.
    $72k-86k yearly est. 60d+ ago
  • Clinical Hemophilia Nurse Liaison - Alaska- Paragon Healthcare

    Carebridge 3.8company rating

    Utilization review nurse job in Oregon

    Be Part of an Extraordinary Team A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting. Title: Clinical Nurse Liaison- Paragon Ideal candidates will reside in Alaska and comfortable traveling 50% of the time between Alaska, Washington, Oregon, and California Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Build the Possibilities. Make an Extraordinary Impact. The Clinical Nurse Liaison- Paragon is responsible to provide patient education and continuing education programs, as well as problem solves and resolves questions and issues for referral sources and patient. How you will make an impact: Primary duties may include, but are not limited to: * Determines clinical and service needs for established and new accounts and referrals. * Effectively communicates with the referral source, branch, physician, and family to coordinate and facilitate plan of care for patients. * Markets all therapies, services, and products to referral sources. * Provides in-services and continuing education programs for hospital case managers and other referral sources and support staff. * Identifies and pulls through appropriate specialty infusion referrals and assists in maximizing revenue within local / regional market. * Partners with leadership team to communicates opportunities for relationship building and business expansion. Minimum Requirements: * Requires a minimum of 3 years of expansive work experience in a clinical environment; or any combination of education and experience which would provide an equivalent background. * Licensed Registered Nurse required. Preferred Skills, Capabilities and Experiences: * Bachelor's degree preferred. * Strongly prefer experience in the home care setting. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $78,016 to $117,024 Locations: California, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $78k-117k yearly Auto-Apply 60d+ ago
  • Nurse Case Manager (RN) - Hep C - MD149

    Native American Rehabilitation Association of The Northwest, Inc. 4.1company rating

    Utilization review nurse job in Portland, OR

    Title: Hepatitis C Nurse Case Manager - RN Wellness Center - 12360 E. Burnside St., Portland, OR 97233 Schedule: This is an in-person position, Monday through Friday, 8:00am - 5:00pm, with occasional evenings or weekends required. Wage Range: $40.00 - $45.00 hourly, non-exempt If you are a motivated and dedicated Nurse Case Manager (RN) looking for an opportunity to contribute to an organization making a positive impact, we want to hear from you! At NARA Northwest, you'll find a supportive work environment where every team member is valued and respected. Whether you're passionate about healthcare, behavioral health, education, or social services, there's a place for you to make a meaningful difference. Company Mission: The mission of NARA NW is to provide education, physical, mental health services, and substance abuse treatment that is culturally appropriate to American Indians, Alaska Natives, and anyone in need. About the Company: At NARA NW, we deliver services and support to Native American and Alaska Native communities, helping individuals lead healthier, more fulfilling lives. With over 450 employees across a variety of programs-including medical and dental care, addiction treatment, housing assistance, and enrichment initiatives NARA NW offers numerous opportunities for growth and advancement, all while making a tangible, positive impact on the lives of others. Position Overview: The Hepatitis C Nurse Case Manager is responsible for providing nursing care and case management services to patients with or at risk for Hepatitis C. This includes conducting testing, delivering patient education, supporting medication adherence, and coordinating treatment plans in both clinical and mobile outreach settings. The Nurse Case Manager will work as part of an integrated care team and collaborate closely with medical providers, community partners, and outreach teams to ensure timely, patient - centered care. The RN will also participate in community education and outreach to raise awareness and engage high-risk populations, with a strong focus on culturally responsive and trauma-informed care. What you will do: * Provides nurse case management services for patients undergoing Hepatitis C testing and treatment, including coordination of care plans, medication adherence support, and follow-up. * Conducts comprehensive patient education on Hepatitis C transmission, prevention, treatment options, and harm reduction strategies. * Monitors treatment progress, tracks outcomes, and updates care plans as needed. * Serves as a patient advocate and liaison between patients, families, healthcare providers, and community partners to ensure seamless and compassionate care. * Collaborates with medical providers, pharmacists, medical assistants, Behavioral Health Consultants, and outreach staff to deliver integrated, patient-centered services. * Delegates appropriate tasks to medical assistants and supports their ongoing training. * Performs Medical tasks as needed, such as patient intake, vital sign collection, risk screening, phlebotomy, and point-of-care testing for HCV, HIV, and STIs following the NARA NW MA Competency Guidebook. * Participates in mobile outreach and community-based services to engage high-risk and underserved populations. * Maintains accurate, timely, and compliant documentation in the Electronic Health Record (EHR) and other required systems. * Exhibits the ability to work with patients of various socio-economic backgrounds and temperaments; demonstrates tact, diplomacy and compassion, responds appropriately in emergency and stressful situations and acts as a patient advocate
    $40-45 hourly 12d ago
  • Clinical Hemophilia Nurse Liaison - Alaska- Paragon Healthcare

    Elevance Health

    Utilization review nurse job in Salem, OR

    **Be Part of an Extraordinary Team** _A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting._ **Title** : **Clinical Nurse Liaison- Paragon** **Ideal candidates will reside in Alaska and comfortable traveling 50% of the time between Alaska, Washington, Oregon, and California** **Field** : This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ **Build the Possibilities. Make an Extraordinary Impact.** The **Clinical Nurse Liaison- Paragon** is responsible to provide patient education and continuing education programs, as well as problem solves and resolves questions and issues for referral sources and patient. **How you will make an impact:** Primary duties may include, but are not limited to: + Determines clinical and service needs for established and new accounts and referrals. + Effectively communicates with the referral source, branch, physician, and family to coordinate and facilitate plan of care for patients. + Markets all therapies, services, and products to referral sources. + Provides in-services and continuing education programs for hospital case managers and other referral sources and support staff. + Identifies and pulls through appropriate specialty infusion referrals and assists in maximizing revenue within local / regional market. + Partners with leadership team to communicates opportunities for relationship building and business expansion. **Minimum Requirements:** + Requires a minimum of 3 years of expansive work experience in a clinical environment; or any combination of education and experience which would provide an equivalent background. + Licensed Registered Nurse required. **Preferred Skills, Capabilities and Experiences:** + Bachelor's degree preferred. + Strongly prefer experience in the home care setting. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $78,016 to $117,024 Locations: California, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $78k-117k yearly 60d+ ago
  • RN - Clinical Nurse Liaison

    Healthmap Solutions 4.2company rating

    Utilization review nurse job in Corvallis, OR

    The Clinical Care Manager is responsible for developing and maintaining long-term relationships with physicians, physician office staff, and Healthmap members that are engaged in Healthmap's Kidney Management Program through coordinating performance improvement activities and care management to improve health outcomes. Responsibilities * Act as a liaison between Healthmap, provider practices and Healthmap members to ensure positive engagement and performance with our program(s) * Develop new provider/partner business relationships that serve as means to better Healthmap provider and member engagement and manage assigned caseload * Identify opportunities to improve health outcomes for Healthmap Solutions members based on provider specific data * Incorporate education and communication on Best Practice sharing, process improvement in provider workflows, Kidney Health Management interventions and HEDIS/STAR measures for identified areas of provider low performance * Identify opportunities to educate provider offices on topics related to Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, etc. * Partner with physicians/physician staff to identify Healthmap Solutions members that would benefit from Care Navigation support, conduct outreach, and engage members in program * Educate Healthmap members on kidney health, related co-morbid conditions, and renal replacement therapy * Serve as Healthmap member advocate, utilize community resources and programs, and serve as liaison between the member, the member's support network, treating physician, and ancillary providers to assist members in meeting individualized goals * Accountable for individual and departmental metrics and key performance indicators as identified by the organization * Ensure timely and successful delivery of reports to internal and external stakeholders * Maintain thorough documentation of all provider meetings/interactions and member interactions for consistency and coordination and in compliance with National Committee for Quality Assurance (NCQA) standards * Ensure Healthmap policies and procedures are followed and complies with HIPAA privacy laws and all other federal, state, and local regulations * Perform other related duties as assigned Requirements * Bachelor's degree required * Active, unrestricted RN license required * Basic Life Support (BLS) certification required for all field roles (within 30 days of hire) * 3+ years of progressive experience in healthcare services, clinical operations, quality, or care management * 3 years of experience in care gap closure or care coordination activities, including those in an outpatient or hospital setting preferred * Prior experience building and managing relationships with health care providers or patients preferred * Proof of valid and unrestricted driver's license required; this position requires regular travel within assigned region to support practices * Must reside in one of the assigned states Must comply with organization policies for health screening and immunizations, including but not limited to: * Current Tuberculosis (TB) test or current chest X-ray * Proof of immunizations (e.g., Hepatitis B, MMR, Varicella, COVID-19, Influenza) * Participation in annual health and wellness screenings Skills * Excellent verbal, written and presentation skills * Interpersonal skills to develop and maintain strong internal and external relationships * Ability to multitask, prioritize, and create solutions in a fast-paced environment * Demonstrated leadership skills and ability to create and maintain a positive work environment * Strong critical thinking and analytical skills * Ability to foster strong employee engagement among the team * Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint Heavy Travel, greater than 50%, across your assigned region. #LI-HYBRID
    $72k-92k yearly est. Auto-Apply 7d ago
  • Nurse Case Manager - Chronic Disease Management Specialist

    DOCS Management Services

    Utilization review nurse job in Coos Bay, OR

    We are currently hiring a Nurse Case Manager - Chronic Disease Management Specialist. If you are an experienced nurse, skilled in case management, an effective motivational interviewer, and value being part of a team that makes a difference, you may be the right person for the position! Apply today! JOB SPECIFICATIONS Classification: Non-exempt | Status: Part-time, Monday - Friday, generally 8am to 5pm, Pacific Time, with flexibility for member needs (occasional evenings/weekends) Salary: $35.29 - $51.38/hourly Department: Utilization Review | Work Location: Hybrid Reports to: Director of Medical Services | Supervision Exercised: Non-supervisory Job Purpose: Chronic Disease Management Specialist The Certified Case Manager (CCM) - Chronic Disease Management Specialist provides comprehensive care coordination and management for members with chronic conditions (e.g., congestive heart failure, diabetes, COPD). This role focuses on improving health outcomes, reducing hospitalizations, and enhancing quality of life through individualized care plans, member education, and collaboration with healthcare teams. The CCM utilizes evidence-based practices and certification skills to optimize resource utilization and support health plan goals. Collaborates with interdisciplinary teams, providers, and community resources to ensure members receive person-centered, culturally responsive, and cost-effective care. Qualifications, Education, & Experience Minimum Associate Degree in Nursing required; Bachelor's degree preferred Certified Case Manager (CCM) credential through the Commission for Case Manager Certification (CCMC) strongly preferred Minimum 3-5 years' experience in case management, chronic disease management, or a related healthcare role; experience in a managed care or health plan setting preferred Additional certifications (e.g., Certified Diabetes Educator) a plus Essential Responsibilities: Certified Case Manager-Chronic Disease Management Specialist Conduct initial and ongoing assessments of member health status, including medical history, functional ability, psychosocial needs, and risk factors Develop and update individualized care plans based on clinical guidelines (e.g., AHA, ADA) and member-centered goals Coordinate with interdisciplinary teams (e.g., physicians, nurses, social workers, pharmacists) to ensure smooth care transitions and continuity of care Support care transitions, including post-discharge planning and follow-up within 48-72 hours Implement disease-specific interventions such as medication adherence support, lifestyle coaching, and dietary education Monitor member progress through routine check-ins (home visits, telephonic, telehealth, etc.) and update care plans based on reassessment Educate members and caregivers on symptom management, self-care, and emergency response plans Review healthcare utilization data to identify cost-effective care opportunities and reduce over-utilization Advocate for appropriate services in alignment with health plan policies and medical necessity guidelines Document assessments, care plans, interventions, and outcomes in member records Provide data and insights to support quality improvement initiatives and performance tracking Link members to appropriate community and support resources (e.g., transportation, palliative care, meal programs) Use technology (e.g., remote monitoring tools) to enhance care management and communication Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER Participate in quality and organizational process improvement activities when requested Support and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer's expectations Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications Advance personal knowledge base by pursuing continuing education to enhance professional competence Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards Represent organization at meetings and conferences as applicable Knowledge, Skills, & Abilities Knowledge of evidence-based practices and requirements to evaluate existing standards and implement new procedures Understanding of principles of health care of populations Knowledge of OHP program requirements, benefit package, eligibility categories, and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred Knowledge of the Oregon Health Authorities Coordinated Care Organization required metrics Understanding of basic concepts of managed care Critical attention to detail for accuracy and timeliness High degree of initiative, judgment, discretion, and decision-making Patient-centered and culturally responsive approach Ability to exercise sound clinical judgment, independent analysis, critical thinking skills, and knowledge of health conditions to determine best outcomes for members Proficient in electronic health record (EHR) systems and case management software (e.g., Optum tools) Knowledge of chronic disease management guidelines and reimbursement models (e.g., Medicare, Medicaid) Strong interpersonal and communication skills for effective member advocacy and interdisciplinary collaboration Commitment to quality improvement, equity, and population health outcomes Ability to report to work as scheduled, and willingness to work a flexible schedule when needed Proficient in Microsoft Office Suite and Windows Operating System (OS) Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access Knowledge and understanding of how the positions' responsibilities contribute to the department and company goals and mission Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices Ability to manage multiple priorities and caseloads effectively Excellent people skills and friendly demeanor Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems Attention to detail and organization skills Ability to handle stress and sensitive situations effectively while projecting a professional attitude Ability to communicate professionally, both conversing and written Ability to work with diverse populations and interact with people of differing personalities and backgrounds Sensitive to economic considerations, human needs and aware of how one's actions may affect others Ability to organize and work in a sensitive manner with people from other cultures Poised; maintains composure and sense of purpose Working Conditions: This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information. Work Condition: hybrid work Employee generally works within the interior of an office or remote work from home environment. Employee may travel locally and be responsible for own transportation. Out of area travel may be required on occasion. Hours of operations and specific staff scheduling may vary based on operational need. The office environment is clean with a comfortable temperature and moderate noise level. Exposed to: Onsite: Cold/heat controls, close contact with employees and the public in office environment. Remote: Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output. Machines, equipment, tools, and supplies used: Constantly operates a computer or other office productivity machinery, such as postage machine, fax, copier, calculator, multi-line telephone system, scanner. May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information. Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task. Other Information: This is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
    $35.3-51.4 hourly 40d ago
  • On Call Nurse - REACH

    Community Counseling Solutions 3.4company rating

    Utilization review nurse job in Hermiston, OR

    NOW HIRING on-call as needed Registered Nurses for REACH, located in Hermiston, Oregon , the new state of the art acute care/secure residential treatment facility (SRTF). Want to pick up extra shifts or be on our on-call list?? RIVER'S EDGE ACUTE CARE CENTER FOR HEALING located in Umatilla County, Oregon near the vast Columbia River and at the base of the beautiful Blue Mountains. This is the perfect location for active outdoor enthusiasts. Providing a family-oriented community with a small home town feel and big city amenities! For over 40 years, we have provided quality behavioral health services for children and families in Eastern Oregon. Community Counseling Solutions provides a team-based Servant Leadership environment! Located in Eastern Oregon with year-round recreation based near the Columbia River and at the base of the Blue Mountains. Big city amenities in rural family-oriented communities. Apply Directly at ********************************** Our mission is to provide dynamic, progressive, and diverse supports to improve the well-being of our communities and we're looking for motivated employees to help us continue our vision! CCS has a benefit package including, but not limited to: Health, dental and vision insurance 6% initial 401K match Potential for tuition reimbursement Generous paid vacation, floating holiday, mental health days, etc. Paid holidays Relocation Benefit of up to $4,000 if moving over 100 miles, $ depending on distance Student loan forgiveness Paid licensure supervision. Employee Assistance & Wellness Benefits JOB TITLE: NURSE LOCATION: REACH, Hermiston FLSA: Non-Exempt - On Call (expectation is pick up shifts as they become available) SUPERVISOR: Nursing Supervisor PAY GRADE: N14 ($53.94 - $65.29 hourly + Shift Differentials for Weeknights (+$2.50/hr.) and Weekends (+$4/hr.)!) DESCRIPTION Provides mental health nursing care, medication oversight and treatment to clients of the REACH Facility. Promotes recovery from mental illness. SUPERVISION Supervision Received This position is supervised by the facility administrator. Supervision Exercised This position does exercise any formal supervision. RESPONSIBILITIES Administers oral medications and hypodermic injections, following physician's prescriptions and procedures. Takes and records measures of patient's general physical condition such as pulse, temperature and respiration to provide daily information. Observes patients to detect behavior patterns and reports observations to medical staff. Leads prescribed individual, group therapy and/or education sessions as part of specific therapeutic procedures. Contact patient's relative by telephone to arrange family conferences. Issues medications from dispensary and maintains records in accordance with specified procedures. Educates staff and patients about personal hygiene such as bathing and keeping beds, clothing and living areas clean. Educates and trains staff on medication administration, ensures documentation is kept according to policies. Must report all abuse to appropriate legal office, complete all necessary paperwork and investigations, and develop safety plans as required. Actively participate in joint case planning and coordination with agency employees and relevant agency contractors. Act as a liaison between clients and other agencies. Act as a client advocate when appropriate. Provide after-hours emergency services on a 24-hour, rotating basis to adults. This includes telephone consultation and crisis intervention in the community and facility. Complete all paperwork in a way that is professional, clinically sound, and timely as prescribed by the OAR's and other pertinent guidelines. Required to ensure that all paperwork is present, and/or the client record is well maintained. Participates in seclusion and restraint practices, as necessary. Conducts various assessments, as needed. Other duties as assigned. Requirements QUALFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Education and Experience Be registered with the State of Oregon as a registered nurse (RN). Be in good standing with the Oregon Board of Nursing. Individual must be able to pass a criminal history background check. Preference given to individuals who have worked with individuals who have mental illnesses in a residential or psychiatric hospital setting. Other Skills and Abilities Possess, or acquire, knowledge of symptoms and challenges faced by people with mental illness and addictions. Must have, or possess the ability to acquire, knowledge about relevant OAR's. Have the ability to effectively communicate both verbally and in writing and have the ability to work independently and complete all responsibility in a thorough and timely fashion. Have skills to professionally work with the public and the ability to coordinate services across various agencies and community groups. Be able to develop cooperative and respectful relationships with clients and their families. Have knowledge, or the ability to acquire knowledge, about the recovery model. Possess the ability to represent the interest of the customer and the agency in a favorable light in the community. Have the ability to work well with teams and other groups of individuals. The position requires the handling of highly confidential information. Must adhere to rules and laws pertaining to client confidentiality. Possess or have the ability to possess functional knowledge of business English and medical terminology. Good spelling and basic mathematical skills. Have the ability to learn assigned tasks readily and to adhere to general office procedures. Good organizational and time management skills are essential. Have in-depth knowledge of standard office equipment. Be able to communicate effectively in both written and oral formats. Must have the ability to present and exchange information internally across teams and co-workers, and externally with customers and the public. Hold a current valid driver's license and be insurable or carry insurance for client service purposes and for travel between business offices, the community, and to attend required meetings and/or training. CRIMINAL BACKGROUND CHECKS Must pass all criminal history check requirements as required by ORS 181.536-181.537 and in accordance with OAR 410-007-0200 through 410-007-0380. In addition to a pre-employment background check, each employee, volunteer, and contractor shall be checked monthly against the OIG and GSA exclusion lists, as well as other federal and state agency lists. If it is discovered that an employee, volunteer, or contractor is excluded or sanctioned it will be grounds for immediate termination of employment, volunteering, or the termination of the contract. PERSONAL AUTO INSURANCE Must hold a valid driver's license as well as personal auto insurance for privately owned vehicles utilized for CCS business such as client service purposes, travel between business offices and the community, to attend required meetings and trainings. Must show proof of $300,000 or more liability coverage for bodily injury and $100,000 or more in property damage and maintain said level of coverage for the duration of employment at CCS. The employee's insurance is primary with CCS insurance being secondary. CCS reserves the right to deny any employee the use of a vehicle owned by CCS. PHYISCAL DEMANDS 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 use hands to finger, handle, smell or feel. The employee frequently is required to stand, walk; and stoop, kneel, crouch or crawl. The employee is occasionally required to climb or balance. The employee must regularly lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and distance vision. WORK ENVIRONMENT Work is performed in an office/home environment as well as in the community. The noise level in the office environment is usually moderate, but occasionally one may be exposed to loud noises. The noise in the community, including the homes of customers, is often difficult to predict. Occasional out of area travel and overnight stays will be required for attendance at meetings and/or training. However, the employee also will be required to work in the community. Handicap access may not be available at all places where this position must go. There are some situations where this position may be required to respond to environments where a client is in crisis. The environments in these situations are difficult to predict and may be in uneven terrain. This position exposes the employee to the everyday risks or discomforts which require normal safety precautions typical of such places as an office or home environment. Community Counseling Solutions IS AN EQUAL OPPORTUNITY EMPLOYER Salary Description $53.94 - $65.29 per hour, depending on experience
    $53.9-65.3 hourly 60d+ ago
  • Nurse Case Manager Hospice

    Physicians Choice Home Health 3.8company rating

    Utilization review nurse job in Wilsonville, OR

    Job Posting: Nurse Case Manager Hospice Starting at $55.00 per hour Company: VistaRiver HealthcareJob Description VistaRiver Healthcare invites qualified nursing professionals to apply for the position of Nurse Case Manager Hospice. This essential role is designed for a compassionate and dedicated individual ready to make a significant difference in the lives of patients and their families during sensitive times. As a Nurse Case Manager specializing in Hospice care, the successful candidate will deliver exceptional patient-centered care grounded in empathy and medical expertise. This is a Full-Time opportunity that requires onsite presence, as it is not a remote position. The chosen candidate will be part of a devoted healthcare team, working to ensure the continuity and quality of care within the community-based settings of our patients. Duties and Responsibilities Completes initial, comprehensive, and ongoing assessments of patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illnesses. Utilizes all elements of the nursing process to provide professional nursing care. Assesses and evaluates patient's status by writing and initiating a plan of care, regularly re-evaluating patient and family/caregiver needs, and participating in revising the plan of care as necessary. Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the physician's plan of care. Counsels the patient and family in meeting nursing and related needs. Provides health care instructions to the patient as appropriate per assessment and plan, assisting the patient with activities of daily living and facilitating the patient's efforts toward self-sufficiency and optimal comfort care. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload. Completes, maintains, and submits accurate and relevant clinical notes regarding patient's condition and care given. Communicates with the physician regarding the patient's needs and reports changes in the patient's condition; obtains/receives physicians' orders as required. Communicates with community health-related persons to coordinate the care plan and teaches the patient and family/caregiver self-care techniques as appropriate. Provides and maintains a safe environment for the patient, assists the patient and family/caregiver and other team members in providing continuity of care. Participates in on-call duties as defined by the on-call policy. Ensures that arrangements for equipment and other necessary items and services are available. Supervises ancillary personnel and delegates responsibilities when required. Actively participates in quality assessment performance improvement teams and activities. Requirements Registered nurse with current licensure to practice professional nursing in the state of Oregon. Graduate of National League for Nursing accredited school of nursing. Maintains a current CPR certification. Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order. Minimum of two years' experience, at least one of which is in the area of public health, home care, or hospice nursing is preferred. Self-directed and able to work with minimal supervision. Experience in supervising hospice aides is not required but responsible for supervising when necessary. Demonstrates excellent observation, problem-solving, verbal, and written communication skills; nursing skills per competency checklist. Ability to organize and prioritize workload independently. Prolonged or considerable walking or standing. Able to lift, position, and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping bending, kneeling, and/or crouching. Visual acuity and hearing to perform required nursing skills.
    $55 hourly 18d ago
  • Flight Nurse

    Life Flight Network 4.3company rating

    Utilization review nurse job in Hillsboro, OR

    Job Description Life Flight Network is one of the most prominent not-for-profit air ambulance organizations. As the industry's trailblazers, we constantly raise the bar for safety, excellence, social justice, and innovation in the skies and on the ground. Being a member of our esteemed team means embarking on a career defined by distinction, pride, compassion, and unwavering service. We are a group of dedicated professionals who thrive in a high-octane, collaborative environment. Our collective brilliance shines as we come together to make a difference in the communities we serve. Here, you'll find the best and the brightest talents, who are second to none in their dedication and expertise. Are you ready to unleash your potential and make a real impact in your community? If you're seeking a rewarding and fulfilling path, then look no further - Life Flight Network is the place where your aspirations will take flight! The Flight Nurse is responsible for working with the Flight Paramedic in the delivery of advanced critical care to patients of the Life Flight Network. The Flight Nurse assumes and is ultimately responsible for all direct patient care in accordance to the guidelines and protocols of Life Flight Network. QUALIFICATIONS & SKILLS Minimum of five (5) years of ICU/ED/Trauma experience within the last ten (10) years. Previous flight experience preferred. Flight experience can be substituted year for year for the ICU/ED/Trauma requirement. Current licensure and/or certification as listed below: RN license as appropriate to assigned location Basic Life Support (BLS) certification Advanced Cardiac Life Support (ACLS) Pre-hospital Trauma Life Support (PHTLS) or Basic Trauma Life Support (BTLS) certification Pediatric Advanced Life Support (PALS Neonatal Resuscitation Program (NRP) certification Transport Professional Advanced Trauma Course (TPATC) certification. Must have successfully completed the TPATC course prior to assuming independent duties. CFRN exam must be taken within one year of hire, certification must be obtained within 2 years of hire Certified Emergency Nurse (CEN) or Critical Care Nurse (CCRN) strongly preferred until certified as a Flight Registered Nurse (CFRN) Drivers must have a current, valid state issued driver's license and at least three years of driving experience. Maintenance of Airport Badge (where applicable) Passport and/or Entry into Canada may be required based on location assignment Complies with weight restrictions (maximum 250 pounds fully outfitted to perform the job) Strong leadership skills and ability to communicate and work with a variety of people one-on-one and in large groups, often in highly stressful situations Ability to work varied shifts and cover fixed wing and/or ambulance call shifts GENERAL ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS CLINICAL QUALITY: The Flight Nurse will perform to the highest standards of nursing. In addition to basic critical care requirements, the Flight Nurse is trained and maintains competency in the following skills: Chest tube insertion, surgical airways, endotracheal intubation, intraosseous insertion, and central line placement. The Flight Nurse, as the senior member of the flight team, is ultimately responsible for all care rendered to the patient. Works with the Flight Paramedic in the delivery of age-appropriate (Pediatric, Adult, Geriatric) patient care Works with the Flight Paramedic as needed in providing accurate and complete patient care documentation per the standards established by LFN Provides written and/or verbal patient follow-up to referring hospitals or agencies Assists with equipment retrieval and return to appropriate agencies Works with the Flight Paramedic in cleaning and restocking equipment in a timely manner to place an aircraft back in service as soon as possible Works with the Flight Paramedic in completing inventories and monthly checks, ordering supplies, and maintaining equipment in working order Works with the Flight Paramedic in the day-to-day operations of LFN May compile statistical data or work on related projects as assigned by the LFN Director of Clinical Operations SAFETY: The expectations of all customers are understood and exceeded through the provision of quality services. Helps to ensure the safe operation of the aircraft for the protection of the patient, crewmembers, and personnel on the scene Enforces LFN safety policies and assists the pilot in navigation, take off, landing, and in-flight procedures BUSINESS DEVELOPMENT: Participates in the development of LFN business and operations plans to meet medical transport service and financial performance goals. Encourages a favorable public opinion of LFN through personal contact with patients, community agencies, and hospitals Provides flight education to the public as requested The above accountabilities represent work performed by this position and are not all-inclusive. The omission of a specific accountability will not preclude it from the position if the work is similar, related, or a logical extension of the position. ???? Benefits That Go Above and Beyond At Life Flight Network, we believe our team members deserve more than just a job - they deserve a rewarding, supported, and balanced life. That's why we offer a thoughtful benefits package that truly sets us apart: Compensation & Retirement Competitive pay 401(k) with a 100% vested employer contribution - your future grows from day one Tenure bonuses to reward your loyalty and long-term commitment Health & Wellness Comprehensive Medical, Dental, and Vision coverage Company-paid Life and AD&D Insurance Company-paid Short & Long-Term Disability Insurance for peace of mind Wellness Reimbursement Program to support your health goals Complimentary Life Flight Network Membership for you and your household Family & Lifestyle Paid Parental Leave to support growing families Adoption Assistance for those building families in new ways Bereavement Leave (including for pets) - because every family member matters Paid Volunteer Time - make a difference in the community, on us Generous Paid Time Off, starting at nearly 4 weeks annually for full-time employees Growth & Recognition Tuition and Training Reimbursement to invest in your professional development Employee Recognition Awards celebrating your impact and achievements Multilingual Stipend to honor the value of diverse communication skills Join Life Flight Network and be part of a team that takes care of those who care for others - both in and out of the workplace. All candidates are subject to drug screening and background investigation. Life Flight Network is an equal opportunity employer.
    $67k-85k yearly est. 6d ago
  • Flight Nurse (RN)

    Mercy Flights Inc. 4.2company rating

    Utilization review nurse job in Medford, OR

    Mercy Flights is hiring for a Flight RN The Flight Nurse (RN) delivers advanced life support and critical care to patients during emergency air (helicopter and fixed-wing) and ground transports. This role provides clinical excellence, safety, and customer service while working collaboratively with flight paramedics, pilots, dispatch, and hospital teams. Key Responsibilities Administer advanced life support and critical care following established protocols. Safely transport patients by air and ground while maintaining excellent communication with dispatch and hospitals. Ensure aircraft and ambulances are clean, stocked, and ready for service. Accurately complete electronic patient care reports and documentation. Participate in continuing education, training, and quality assurance activities. Serve as a professional and compassionate representative of Mercy Flights. Qualifications Current Oregon RN license (required) Minimum 3 years of recent ICU or ED experience BLS, ACLS, and PALS (or PEPP) certifications required CFRN (Certified Flight RN) - required within 18 months of hire NRP and TPATC - required within 12-18 months of hire Oregon EMT or Paramedic license preferred Valid Oregon Driver's License (within 30 days of hire) Must meet physical and weight requirements ( How to apply: Apply online at: ********************* To ensure consideration, a completed resume and Mercy Flights application must be received. Incomplete applications and/or resumes will not be accepted or considered for review. This position will remain open until filled. Mercy Flights is a drug free workplace and follows federal guidelines set by the United States Department of Labor to provide a safe and drug-free work environment. Mercy Flights is an Equal Opportunity Employer
    $64k-82k yearly est. Auto-Apply 49d ago
  • Unit Support Nurse

    Marquis Companies 4.5company rating

    Utilization review nurse job in Newberg, OR

    Unit Support Nurse JOIN AN OUTSTANDING TEAM! What's your wish list for the perfect job? Maybe it's to make a positive impact in the world, or to grow your career. Maybe working with a great team is top priority, or to feel respected and valued. If your answer is "all of the above", consider becoming a Unit Support Nurse at Marquis Companies. It's an opportunity for compassionate people to make a difference in a highly supportive and rewarding environment. Simply put, as the Unit Support Nurse, you will assist the Charge Nurses, Resident Care Managers, and other nursing staff with daily duties to ensure a smoothly run facility. This position is the main point of contact at the Nursing Station to address family, nursing, and doctor's needs. As the Unit Support Nurse, you will see that the duties you perform make a noticeable difference in the lives of your residents and colleagues. Marquis operates 26 senior care facilities in Oregon, Nevada, California, and provides rehab and pharmacy services across the nation. You'll be joining a family of more than 4,000 employees, and one purpose unites us all-to be champions of every journey. In addition to a wide variety of career opportunities, we offer a comprehensive benefits package that can include: * Competitive Wages * Paid Vacation and Sick Time * Medical, Dental, and Vision Insurance * Life insurance, short term disability, AD&D coverage * Flex Spending for Medical & Dependent Care * 401(k) Plan with Employer Match * Continual growth opportunities & up to $25,000 towards ongoing education * Uniforms provided upon hire & on employment anniversary * Employee Referral Bonus * Employee Assistance Program * Employee cell phone discount * Vital Life Foundation contribution for non-profit Volunteer hours Qualifications * Passionate about helping seniors live their best life! * Must be an LPN or RN in the appropriate state. EEO Statement "Be here. Be you." For more than 30 years, Marquis Companies and Consonus Healthcare have been serving seniors and welcoming staff of all backgrounds, skills, and perspectives. The Marquis family of companies offer a rich heritage of embracing differences and honoring individuality. We've continued to grow in our appreciation of diversity in the workplace. We know it builds strength, drives innovation, and brings valuable new perspectives and energy. We're committed to making our workforce an even greater reflection of the people and communities we serve, and we are honored our employees have chosen to work at Marquis and Consonus. Everything we do as a company is driven by our mission to help those we serve, and each other, live the best rest of our lives. That means you being you - without apology or compromise. We value your every uniqueness and continue to curate, nurture, and sustain an inclusive culture. It's the foundation of who we are and the evolution of our collective future.
    $66k-83k yearly est. Auto-Apply 3d ago
  • Summer Camp Nurse

    YMCA of Columbia-Willamette 4.2company rating

    Utilization review nurse job in Gresham, OR

    Requirements Minimum Qualifications: · RN and license to practice in Oregon, LNP, EMT, or WEMT · Minimum Age 21 · First Aid Certification · Adult, Child & Infant CPR and AED Certification · Must pass YMCA background check Preferred Qualifications: · Experience working with youth · 2 years of camping experience or combination of youth program and supervisory experience. · Driver's License with clean driving record Essential Functions: · Requires strong communication skills, positive attitude, initiative, flexibility, dependability, creativity and ability to work and problem solve as a team player. · Mental and physical ability to deal with high stress situations and work well under pressure. · Ability to perform multiple tasks concurrently. · Ability to support and connect with campers and staff. · Visual and auditory ability to respond to critical incidents and the physical abilities to act swiftly in an emergency situation. · Knowledge of/practical experience in: cabin leadership, camper psychology, peer leadership and supervision; staff management & motivation. · Ability and willingness to learn on the job in an environment that changes quickly. · Must be able to lift at least 50 pounds.
    $59k-71k yearly est. 60d+ ago
  • Utilization Review Nurse

    Umpqua Health 3.8company rating

    Utilization review nurse job in Roseburg, OR

    JOB TITLE Utilization Review Nurse REPORTS TO Utilization Review, Manager STATUS FT, Exempt WAGE RANGE Grade 20 (2024) DEPARTMENT Utilization Management WORK LOCATION Remote (occasional travel as required) POSITION PURPOSE The Utilization Management Nurse is responsible for evaluating clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role applies professional nursing judgment to conduct prior authorization reviews, facilitate care coordination, and support transitions across care settings. The nurse ensures compliance with Oregon Health Plan (OHP), Medicare, and applicable regulatory guidelines, while a assuring member access to appropriate services. Through collaboration with interdisciplinary teams and community providers, the Utilization Management Nurse promotes integrated, high-quality care and contributes to continuous improvement in utilization management processes. ESSENTIAL JOB RESPONSIBILITIES Performing clinical assessments of various medical service requests to determine medical necessity, appropriateness, and alignment with evidence-based guidelines and benefit coverage. Conduct prior authorization and HRS flex reviews, applying nursing judgment to ensure timely, cost-effective, and high-quality care delivery. Identify and escalate complex or non-standard cases to Medical Directors; request and evaluate additional clinical documentation as needed. Collaborate with care coordinators, discharge planners, and interdisciplinary teams to support integrated care and safe transitions across care settings. Maintain up-to-date knowledge of Oregon Health Plan (OHP), Medicare, and applicable regulatory frameworks (OAR, ORS, CFR, CMS, DMAP). Serve as a clinical liaison with internal departments (e.g., Third-Party Recovery, Customer Care) to resolve eligibility, coordination of benefits, and stop-loss concerns. Ensuring access to appropriate services in the least restrictive setting, while supporting continuity and quality of care. Participate in discharge planning for members transitioning from acute, long-term, or residential care to community-based services, ensuring holistic support for physical and behavioral health needs. Conduct departmental audits and contribute to quality improvement initiatives by identifying trends and recommending process enhancements. Provide training and mentorship to new and cross-functional staff on clinical workflows and UM protocols. Build and maintain collaborative relationships with community providers and service organizations to support member care plans. Ensure compliance with organizational policies, clinical standards, and all applicable federal and state regulations. Conduct work independently and in collaboration with the Utilization Management (UM) team to ensure accurate and appropriate determinations. Perform other nursing-related duties as assigned. CHALLENGES Working with a variety of personalities, maintaining a consistent and fair communication style. Satisfying the needs of a fast paced and challenging company. QUALIFICATIONS Minimum Qualifications Licensure: Active, unrestricted Registered Nurse (RN), BSN (Bachelor of Science in Nursing, MSN (Master of Science in Nursing) license in the state of Oregon or a compact state. Education: Graduation from an accredited nursing program. Experience: Minimum of five (5) years of direct patient care experience in a clinical setting, such as a medical office, hospital, or long-term care facility. Core Competencies & Skills Clinical Nursing Expertise: Deep understanding of medical terminology, diagnoses, procedures, and care modalities. Experienced in interpreting clinical documentation and applying nursing knowledge to support utilization review and care decisions. Utilization Management: Proficient in InterQual criteria, UM software, and evidence-based guidelines. Skilled in reviewing requests for medical services and ensuring appropriate use of resources. Regulatory Compliance: Strong working knowledge of NCQA standards, Oregon Health Plan (OHP), and Coordinated Care Organization (CCO) regulations, including OAR, ORS, CFR, CMS, DMAP, and the Prioritized List of Health Services. Medical Coding & Insurance: Familiar with ICD and CPT codes, health insurance processes, and state-mandated benefits. Technology & Documentation: Proficient in Microsoft Office (Word, Excel, Outlook), EHR systems, and managed care platforms. Accurate typing at 45+ WPM. Communication & Collaboration: Excellent interpersonal, written, and verbal communication skills. Builds strong relationships with providers, community services, and internal teams. Organization & Problem Solving: Highly organized and detail-oriented. Capable of managing multiple priorities, analyzing complex situations, and developing effective solutions. Ethical Standards: Maintains compliance with federal healthcare program requirements. No suspension, exclusion, or debarment from Medicare/Medicaid. Preferred Qualifications Two (2) years of utilization review or case management experience in a managed care organization or commercial insurance. Oregon residency and Oregon nursing license. Proficient in electronic systems for data entry and retrieval. Strong critical thinking, time management, and organizational skills to meet goals and deadlines. Demonstrated ability to work independently and collaboratively in fast-paced environments. Committed to continuous learning and expanding responsibilities. Knowledgeable in contractual benefits and alternative coverage options. Maintains patient confidentiality and secure health record practices. Current clinical certification and up-to-date knowledge base. Capable of conducting quality improvement audits and reporting findings. Effective in managing multiple priorities with attention to detail and accuracy. Experience working on diverse teams and considering equity impacts in decision-making. Bilingual capabilities or translation experience is a plus. PHYSICAL DEMANDS & WORK CONDITIONS A typical office environment requires standing, sitting, walking, bending, and lifting up to 25 plus pounds. Ability to travel and drive to in-person meetings or be on-site as required. May be exposed to patient and environment conditions such as unpleasant sights, smells and contagious diseases (clinic only). EQUAL EMPLOYMENT OPPORTUNITY UH is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. UH makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, read through our EEO Policy. ACKNOWLEDGEMENT I have reviewed the attached as outlined above and understand that I am responsible for all duties as outlined and other tasks as may be assigned. I understand that if I need accommodation to perform the essential functions of my job that I must contact my supervisor or Human Resources as soon as possible to begin an interactive process. Note: This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. EMPLOYEE SIGNATURE DATE About Umpqua Health At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health. Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
    $79k-94k yearly est. Auto-Apply 60d+ ago
  • Drug Utilization Review Pharmacist

    Pharmacy Careers 4.3company rating

    Utilization review nurse job in Beaverton, OR

    Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.
    $72k-86k yearly est. 60d+ ago
  • RN - Clinical Nurse Liaison

    Healthmap Solutions 4.2company rating

    Utilization review nurse job in Corvallis, OR

    at Healthmap Solutions Company Background Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most. Position Summary The Clinical Care Manager is responsible for developing and maintaining long-term relationships with physicians, physician office staff, and Healthmap members that are engaged in Healthmap's Kidney Management Program through coordinating performance improvement activities and care management to improve health outcomes. Responsibilities Act as a liaison between Healthmap, provider practices and Healthmap members to ensure positive engagement and performance with our program(s) Develop new provider/partner business relationships that serve as means to better Healthmap provider and member engagement and manage assigned caseload Identify opportunities to improve health outcomes for Healthmap Solutions members based on provider specific data Incorporate education and communication on Best Practice sharing, process improvement in provider workflows, Kidney Health Management interventions and HEDIS/STAR measures for identified areas of provider low performance Identify opportunities to educate provider offices on topics related to Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, etc. Partner with physicians/physician staff to identify Healthmap Solutions members that would benefit from Care Navigation support, conduct outreach, and engage members in program Educate Healthmap members on kidney health, related co-morbid conditions, and renal replacement therapy Serve as Healthmap member advocate, utilize community resources and programs, and serve as liaison between the member, the member's support network, treating physician, and ancillary providers to assist members in meeting individualized goals Accountable for individual and departmental metrics and key performance indicators as identified by the organization Ensure timely and successful delivery of reports to internal and external stakeholders Maintain thorough documentation of all provider meetings/interactions and member interactions for consistency and coordination and in compliance with National Committee for Quality Assurance (NCQA) standards Ensure Healthmap policies and procedures are followed and complies with HIPAA privacy laws and all other federal, state, and local regulations Perform other related duties as assigned Requirements Bachelor's degree required Active, unrestricted RN license required Basic Life Support (BLS) certification required for all field roles (within 30 days of hire) 3+ years of progressive experience in healthcare services, clinical operations, quality, or care management 3 years of experience in care gap closure or care coordination activities, including those in an outpatient or hospital setting preferred Prior experience building and managing relationships with health care providers or patients preferred Proof of valid and unrestricted driver's license required; this position requires regular travel within assigned region to support practices Must reside in one of the assigned states Must comply with organization policies for health screening and immunizations, including but not limited to: Current Tuberculosis (TB) test or current chest X-ray Proof of immunizations (e.g., Hepatitis B, MMR, Varicella, COVID-19, Influenza) Participation in annual health and wellness screenings Skills Excellent verbal, written and presentation skills Interpersonal skills to develop and maintain strong internal and external relationships Ability to multitask, prioritize, and create solutions in a fast-paced environment Demonstrated leadership skills and ability to create and maintain a positive work environment Strong critical thinking and analytical skills Ability to foster strong employee engagement among the team Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint Heavy Travel, greater than 50%, across your assigned region. #LI-HYBRID Americans with Disability Specifications 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. As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.
    $72k-92k yearly est. Auto-Apply 7d ago
  • Nurse Case Manager Hospice

    Physicians Choice Home Health 3.8company rating

    Utilization review nurse job in Wilsonville, OR

    Job Posting: Nurse Case Manager Hospice Starting at $55.00 per hour Company: VistaRiver HealthcareJob Description VistaRiver Healthcare invites qualified nursing professionals to apply for the position of Nurse Case Manager Hospice. This essential role is designed for a compassionate and dedicated individual ready to make a significant difference in the lives of patients and their families during sensitive times. As a Nurse Case Manager specializing in Hospice care, the successful candidate will deliver exceptional patient-centered care grounded in empathy and medical expertise. This is a Full-Time opportunity that requires onsite presence, as it is not a remote position. The chosen candidate will be part of a devoted healthcare team, working to ensure the continuity and quality of care within the community-based settings of our patients. Duties and Responsibilities Completes initial, comprehensive, and ongoing assessments of patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illnesses. Utilizes all elements of the nursing process to provide professional nursing care. Assesses and evaluates patient's status by writing and initiating a plan of care, regularly re-evaluating patient and family/caregiver needs, and participating in revising the plan of care as necessary. Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the physician's plan of care. Counsels the patient and family in meeting nursing and related needs. Provides health care instructions to the patient as appropriate per assessment and plan, assisting the patient with activities of daily living and facilitating the patient's efforts toward self-sufficiency and optimal comfort care. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload. Completes, maintains, and submits accurate and relevant clinical notes regarding patient's condition and care given. Communicates with the physician regarding the patient's needs and reports changes in the patient's condition; obtains/receives physicians' orders as required. Communicates with community health-related persons to coordinate the care plan and teaches the patient and family/caregiver self-care techniques as appropriate. Provides and maintains a safe environment for the patient, assists the patient and family/caregiver and other team members in providing continuity of care. Participates in on-call duties as defined by the on-call policy. Ensures that arrangements for equipment and other necessary items and services are available. Supervises ancillary personnel and delegates responsibilities when required. Actively participates in quality assessment performance improvement teams and activities. Requirements Registered nurse with current licensure to practice professional nursing in the state of Oregon. Graduate of National League for Nursing accredited school of nursing. Maintains a current CPR certification. Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order. Minimum of two years' experience, at least one of which is in the area of public health, home care, or hospice nursing is preferred. Self-directed and able to work with minimal supervision. Experience in supervising hospice aides is not required but responsible for supervising when necessary. Demonstrates excellent observation, problem-solving, verbal, and written communication skills; nursing skills per competency checklist. Ability to organize and prioritize workload independently. Prolonged or considerable walking or standing. Able to lift, position, and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping bending, kneeling, and/or crouching. Visual acuity and hearing to perform required nursing skills.
    $55 hourly 60d+ ago
  • Float Flight Nurse

    Life Flight Network 4.3company rating

    Utilization review nurse job in Pendleton, OR

    Job Description Life Flight Network is one of the most prominent not-for-profit air ambulance organizations. As the industry's trailblazers, we constantly raise the bar for safety, excellence, social justice, and innovation in the skies and on the ground. Being a member of our esteemed team means embarking on a career defined by distinction, pride, compassion, and unwavering service. We are a group of dedicated professionals who thrive in a high-octane, collaborative environment. Our collective brilliance shines as we come together to make a difference in the communities we serve. Here, you'll find the best and the brightest talents, who are second to none in their dedication and expertise. Are you ready to unleash your potential and make a real impact in your community? If you're seeking a rewarding and fulfilling path, then look no further - Life Flight Network is the place where your aspirations will take flight! The Flight Nurse is responsible for working with the Flight Paramedic in the delivery of advanced critical care to patients of the Life Flight Network. The Flight Nurse assumes and is ultimately responsible for all direct patient care in accordance to the guidelines and protocols of Life Flight Network. QUALIFICATIONS & SKILLS Minimum of five (5) years of ICU/ED/Trauma experience within the last ten (10) years. Previous flight experience preferred. Flight experience can be substituted year for year for the ICU/ED/Trauma requirement. Current licensure and/or certification as listed below: RN license as appropriate to assigned location Basic Life Support (BLS) certification Advanced Cardiac Life Support (ACLS) Pre-hospital Trauma Life Support (PHTLS) or Basic Trauma Life Support (BTLS) certification Pediatric Advanced Life Support (PALS Neonatal Resuscitation Program (NRP) certification Transport Professional Advanced Trauma Course (TPATC) certification. Must have successfully completed the TPATC course prior to assuming independent duties. CFRN exam must be taken within one year of hire, certification must be obtained within 2 years of hire Certified Emergency Nurse (CEN) or Critical Care Nurse (CCRN) strongly preferred until certified as a Flight Registered Nurse (CFRN) Drivers must have a current, valid state issued driver's license and at least three years of driving experience. Maintenance of Airport Badge (where applicable) Passport and/or Entry into Canada may be required based on location assignment Complies with weight restrictions (maximum 250 pounds fully outfitted to perform the job) Strong leadership skills and ability to communicate and work with a variety of people one-on-one and in large groups, often in highly stressful situations Ability to work varied shifts and cover fixed wing and/or ambulance call shifts GENERAL ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS CLINICAL QUALITY: The Flight Nurse will perform to the highest standards of nursing. In addition to basic critical care requirements, the Flight Nurse is trained and maintains competency in the following skills: Chest tube insertion, surgical airways, endotracheal intubation, intraosseous insertion, and central line placement. The Flight Nurse, as the senior member of the flight team, is ultimately responsible for all care rendered to the patient. Works with the Flight Paramedic in the delivery of age appropriate (Pediatric, Adult, Geriatric) patient care Works with the Flight Paramedic as needed in providing accurate and complete patient care documentation per the standards established by LFN Provides written and/or verbal patient follow-up to referring hospitals or agencies Assists with equipment retrieval and return to appropriate agencies Works with the Flight Paramedic in cleaning and restocking equipment in a timely manner to place an aircraft back in service as soon as possible Works with the Flight Paramedic in completing inventories and monthly checks, ordering supplies and maintaining equipment in working order Works with the Flight Paramedic in day-to-day operations of LFN May compile statistical data or work on related projects as assigned by the LFN Director of Clinical Operations SAFETY: The expectations of all customers are understood and exceeded through the provision of quality services. Helps to ensure the safe operation of the aircraft for the protection of the patient, crewmembers and personnel on the scene Enforces LFN safety policies and assists the pilot in navigation, take off, landing and in-flight procedures BUSINESS DEVELOPMENT: Participates in the development of LFN business and operations plans to meet medical transport service and financial performance goals. Encourages a favorable public opinion of LFN through personal contact with patients, community agencies and hospitals Provides flight education to the public as requested The above accountabilities represent work performed by this position and are not all-inclusive. The omission of a specific accountability will not preclude it from the position if the work is similar, related, or a logical extension of the position. BENEFITS LFN offers competitive compensation above industry standard Medical Dental Vision Life/AD&D (Company pays for employee 100%) Short & long term disability (Company pays for employee 100%) 401k - with 100% vested employer contribution Multilingual Stipend Tenure bonuses Adoption assistance Paid parental time off Bereavement leave (including pets) Tuition/Training reimbursement Paid volunteer time Employee Recognition Awards A generous paid time off plan starting at almost 4 weeks a year for full time employees Wellness Reimbursement Program Life Flight Network Membership All candidates are subject to drug screening and background investigation. Life Flight Network is an equal opportunity employer.
    $64k-80k yearly est. 11d ago
  • Summer Camp Nurse

    YMCA of Columbia Willamette 4.2company rating

    Utilization review nurse job in Gresham, OR

    YMCA OF COLUMBIA-WILLAMETTE Camp Nurse Department: Summer Camp Supervisor: Director, Youth Development Scheduled Hours: Sunday to Friday Full Time/Part Time: Seasonal The YMCA of Columbia-Willamette is a mission driven organization, which seeks individuals who are enthusiastic and passionate about our mission and vision. We do this by putting the Christian principles of love, respect, honesty, responsibility and service into practice. Objective: Under Supervision of the Director, Youth Development, the Health Officer works to maintain a safe and healthy camp environment using preventive care and risk management techniques in a manner that is consistent with the staff code of conduct and the philosophy, goals, and objectives of YMCA Camp Collins. Job Responsibilities: Work with the staff team in responding to the medical needs of campers and staff. Be an active and supportive member of the camp community and help to create an enjoyable experience for all campers and staff. Be an active and supportive member of the Leadership Team. Job Specifics: 1. Incorporate and Model our YMCA Christian principles of love, respect, honesty, responsibility and service into your work. 2. Commit to establishing long-term relationships with staff, volunteers, campers and families. 3. Care for Campers/Staff who are Ill or Injured at Camp 4. Leadership Team: Demonstrate professional role modeling at all times, work to establish and maintain positive relationships with leadership team members, communicate regularly with summer program director, fulfill leadership team duties, and complete a thorough end of summer report. 5. Support Staff through building authentic relationships, coaching and evaluations (formal and informal), following up on camper behavior management, supporting staff through challenging situations, following through with commitments, helping staff grow professionally and personally, maintaining positive relationships throughout the summer, and serving as a liaison between staff and Leadership Team. 6. Health House Operations 7. Support and direct the assistant health officer and inclusion counselors. 8. Conduct Appropriate Parent Communication by acting proactively regarding camper concerns, being consistent and timely in inclusion of parent in updates on camper situations, and follow up with parental inquiries in a timely manner. 9. Perform other duties as assigned Key Results: Demonstrates in word and action the Y's Christian principles of love, honesty, respect, responsibility and service and a commitment to the Y's vision and mission. Builds authentic relationships in the service of enhancing individual and team performance to support the Y's work. Listens and expresses self effectively and in a manner that reflects a true understanding of the needs of the audience. Values all people for their unique talents and takes an active role in promoting practices that support diversity, inclusion, and cultural competence. Demonstrates and fosters a strong commitment to achieving goals in a manner that provides quality experiences. Has the functional and technical knowledge and skills to do the job at a high level of accomplishment. Assesses, minimizes and prevents risk, practices consideration for the safety of others, adheres to Association standards of proper notification of incidents and care of the work environment and equipment, identifies and responds to circumstances appropriately. Meets attendance expectations, follows Association procedures for requesting and documenting absences, is punctual, reliable, and adaptable, takes initiative, and accepts responsibility. Demonstrates effective interpersonal skills, perceives, understands and manages interactions appropriately, is accountable for own actions, capitalizes on learning opportunities, and is open to performance feedback and coaching. 10. Demonstrates compliance in the following areas: Collaboration, employee paperwork, performance evaluations, personnel policies, and procedures i.e. dress code, code of conduct. Attends mandatory trainings and meetings, acquires and maintains required certifications for current position. 11. Supports Staff: creates clear expectations, conducts weekly in-service trainings, help staff develop creative and age-appropriate activities and teaching methods. 12. Demonstrates professional role modeling at all times. Works to establish and maintain positive relationships with team members. Fulfills leadership team duty responsibilities. Requirements Minimum Qualifications: · RN and license to practice in Oregon, LNP, EMT, or WEMT · Minimum Age 21 · First Aid Certification · Adult, Child & Infant CPR and AED Certification · Must pass YMCA background check Preferred Qualifications: · Experience working with youth · 2 years of camping experience or combination of youth program and supervisory experience. · Driver's License with clean driving record Essential Functions: · Requires strong communication skills, positive attitude, initiative, flexibility, dependability, creativity and ability to work and problem solve as a team player. · Mental and physical ability to deal with high stress situations and work well under pressure. · Ability to perform multiple tasks concurrently. · Ability to support and connect with campers and staff. · Visual and auditory ability to respond to critical incidents and the physical abilities to act swiftly in an emergency situation. · Knowledge of/practical experience in: cabin leadership, camper psychology, peer leadership and supervision; staff management & motivation. · Ability and willingness to learn on the job in an environment that changes quickly. · Must be able to lift at least 50 pounds.
    $59k-71k yearly est. 60d+ ago

Learn more about utilization review nurse jobs

Do you work as a utilization review nurse?

What are the top employers for utilization review nurse in OR?

Top 3 Utilization Review Nurse companies in OR

  1. Umpqua Community Health Center, Inc

  2. Pharmacy

  3. Centerwell

Job type you want
Full Time
Part Time
Internship
Temporary

All utilization review nurse jobs

Jobs in Oregon