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Estimated Hiring Range:

Bonus Target:

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

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Essential Responsibilities

• Complete Quality of Care reviews.
• Work closely with the director of Quality of Care to ensure quality and clinical issues are addressed in a timely and thorough manner.
• Maintain accurate and complete documentation for files related to quality of care.
• Utilize enterprise tools such as QNXT, Sharepoint and smartsheets to aid in quality monitoring.
• Coordinate and facilitate risk reduction strategies for quality and patient safety issues when opportunities are identified.
• Collaborate with other departments in ensuring quality of care process is working effectively.
• Conduct annual and other trainings as needed.
• Coordinate and facilitate risk reduction strategies for quality and patient safety issues when opportunities are identified.
• Take lead in the implementation and ongoing administration of health improvement programs and provide ongoing feedback to Quality of Care Director and others as appropriate.
• Identify education/ training programs for network providers, members, other health care workers and CareOregon staff in support of appeals and grievance process.
• Develop and monitor a tracking system to ensure accuracy of data, tracking and trending of providers with quality of care issues and other possible data sources related to clinical quality.
• Provide clinical expertise to other department members, in evaluation of program outcomes, providing input for program activities.
• Ability to apply CMS, OAR, Contract Requirements and other regulatory standards when performing work.
• Apply the Equity First approach when conducting work and participate in helping to develop and implement the Equity First approach.
• Participate in committees such as contract review, peer review and quality oversight as needed.
• Participate in Provider site visits as needed.

Experience and/or Education

Required

• Minimum 3 years of experience as an RN in the healthcare industry
• Current unrestricted license as a registered nurse in the State of Oregon

Preferred

• Bachelor’s degree in Nursing
• Prior primary care and/or specialty clinic practice experience and behavioral health experience highly desired
• RN experience with quality improvement, population health and/or case management

Knowledge, Skills and Abilities Required

Knowledge

• Knowledge of or desire to learn about current clinical practices specifically issues related to quality of care for our members

Skills and Abilities

• Ability to efficiently glean clinical information from a medical record, or other specialized software, and save supporting documentation in appropriate data management tool
• Critical thinking skills
• Strong attention to detail
• Competency with computers and software programs, e.g. PDF, MS Outlook, Word, Excel and EMR systems
• Ability to learn and adapt to new EMR systems, software programs, specification changes and deadlines
• Ability to maintain strict confidentiality of protected health information
• Awareness of the social determinants of health impacting CareOregon members and approaching interactions with clinics, members or CareOregon embedded staff with kindness and friendliness
• Ability to work in an environment with diverse individuals and groups
• Have a high degree of initiative and motivation along with ability to effectively collaborate and plan with co-workers and others
• Ability to manage multiple tasks and flexibility to switch tasks as needed
• Act professionally at all times when representing CareOregon
• Ability to work under pressure and help the team meet deadlines for regulatory deliverables
• Good written and verbal communication skills
• Excellent customer service skills and ability to work across multiple departments
• Ability to prioritize work in a remote environment
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day
• Ability to lift, carry, push, pull, and/or pinch small objects for at least 1-3 hours/day

Working Conditions

Work Environment(s):         ☒ Indoor/Office    ☒ Community      ☐ Facilities/Security                       ☐ Outdoor Exposure

Member/Patient Facing:     ☒ No                        ☐ Telephonic       ☐ In Person

Hazards:  May include, but not limited to, physical and ergonomic hazards

Equipment:  General office equipment

Travel:  May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used

Work Location: Hybrid-Office 1-2 days/month

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.  Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.