RN Behavioral Health Case Manager

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary
The Case Manager performs case management within the boundaries of accreditation organization standards to ensure appropriate care is delivered in a timely manner and within the appropriate setting for Moda Health and Summit Health members.  Interacts with the member, family, and care providers within a Motivational Interviewing framework to develop, coordinate, and monitor the member’s treatment plan. This is a FT WFH position. 

The salary range for this position is $71,990.85 - $89,988.57 DOE.
*This role may be classified as hourly (non-exempt) depending on the applicant's location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27783904&refresh=true

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Primary Functions:

1. Responsible for core activities of case management, including assessment, planning, implementation, coordination, monitoring, and evaluation of member needs and outcomes.
2. Conducts comprehensive biopsychosocial assessments to identify behavioral health, medical, social, and environmental needs, barriers, and opportunities for intervention.
3. Develops individualized care plans with measurable goals and interventions designed to support member engagement, recovery, stabilization, and overall health outcomes.
4. Coordinates services across behavioral health, medical, community, and social support systems to promote integrated and cost-effective care.
5. Monitors member progress, treatment adherence, and effectiveness of interventions, modifying care plans as clinically appropriate.
6. Utilizes evidence-based practices, clinical criteria, and current behavioral health standards to support care management activities and clinical decision-making.
7. Engages members and families using motivational interviewing, trauma-informed communication, and member-centered approaches to support activation and participation in treatment.
8. Collaborates with internal multidisciplinary teams, providers, facilities, community agencies, and physician advisors to ensure clinically appropriate and coordinated care.
9. Supports smooth transitions of care, including coordination following inpatient admissions, emergency department visits, residential treatment, and other acute behavioral health episodes.
10. Identifies members appropriate for case management through referrals, utilization trends, claims data, and other internal or external sources.
11. Serves as a behavioral health resource to internal and external stakeholders regarding care coordination, treatment planning, and available resources.
12. Collaborates with other departments to resolve claims, quality of care, member, or provider concerns and participates in interdisciplinary problem-solving efforts.
13. Identifies opportunities for process improvement, recommends solutions, and participates in quality improvement and accreditation-related activities.
14. Responds to members, providers, regulatory agencies, and community partners in a professional and confidential manner via written and verbal communication.
15. Maintains timely, accurate, and thorough documentation consistent with organizational policies, accreditation standards, and regulatory requirements.
16. Plans, organizes, and prioritizes work assignments to meet productivity standards, corporate goals, and established timelines.
17. Other duties and responsibilities as assigned.

Required Skills, Experience & Education:

• Graduate of an accredited school of Nursing or Social Work.
• Requires a current unrestricted Oregon license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW).  
• Certification in case management (CCMC) required or ability to obtain within 24 months of hire.
• Must have recent healthcare experience in acute care and/or skilled nursing care.  To include medical, surgical, and behavioral health knowledge and experience.
• Proficient with Microsoft Office applications and type a minimum of 35 wpm on a computer keyboard.
• Strong analytical, problem-solving, memory retention, organizational, and detail-oriented skills.
• Exceptional verbal and interpersonal communication skills, including management of angry customers.
• Ability to work well under pressure.
• Project a professional business image telephonically and in person.
• Ability to come in to work on time and on a daily basis.

Contact with Others & Working Conditions: 

• Occasionally may need to work in excess of 40 hours per week, including evenings and during the weekend to meet business needs.
  Prolonged amounts of sitting and working on PC with extensive keyboard and telephonic work daily. Occasional travel for meetings outside of the office.

• Internally with all departments and levels of staff. Externally with community organizations, state agencies, providers and office staff, healthcare associations and representatives, and members.

Together, we can be more. We can be better.
 
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 

For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our humanresources@modahealth.com email.