HRSN Specialist RN I

EXPERIENCE/EDUCATION/QUALIFICATIONS: Current unencumbered Oregon RN License required. BSN preferred. One (1) year clinical nursing experience required. Experience or training in the following required: Health care delivery systems and/or managed care patients. Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced). Experience in the following preferred: Utilization management. Medicare and Medicaid rules and regulations and health plan benefit structure and policy. KNOWLEDGE/SKILLS/ABILITIES: Knowledge of social determinants of health (SDoH) and the relationship to the member’s overall wellbeing. Knowledge of HRSN benefit, managed care principles, OHA requirements and OHP benefits and ability to incorporate this information into the HRSN coordination process. Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services and evaluation of customer service satisfaction. Ability to work, function and communicate on a multi-disciplinary team. Possess the knowledge and skills to develop constructive and cooperative working relationships with others and maintain them over time. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities. Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions respond quickly and appropriately. Ability to organize, plan and prioritize work to complete within required time frames and to follow-up on pending issues. Knowledge of medical terminology, ICD, CPT, and HCPCS codes. Strong communication skills (telephone skills with members, CBOs, interdepartmental communication).

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