Nurse (Case Management)

About the role

This position is located at the Western Oregon Service Unit in Salem, Oregon and the Warm Springs Service Unit in Warm Springs, Oregon. The purpose of the role is to provide case management and care coordination for patients requiring special health care needs. The incumbent reports to the Director of Nursing or designee. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021).

Responsibilities

• Review outpatient consultations/referrals to determine if the referral meets established criteria of the current priority level, monitor for alternate resources available, assess justification for services requested, and evaluate the referral request.
• Collaborate with the Purchase Referred Care (PRC) department and medical providers to determine medical necessity and appropriateness of referrals, and make in‑house referrals when necessary.
• Monitor patient status, ensure primary care teams are notified of progress on patient referrals, and verify that services are being delivered as planned.
• Respond to insurance