Clinical Documentation Specialist RN *Hybrid*

Clinical Documentation Specialist RN *Hybrid*

The MCO Clinical Reviewer is accountable for utilization management activities including evaluation of appropriateness and medical justification of health services for MCO eligibles. The position has specific focus on researching, developing, and communicating implementation of Medical Policies, including facilitating Medical Policy Committee work. In addition, the position is responsible for providing medical treatment reviews, case management, and treatment interventions the promote cost effective medical care and early return to work in workers' compensation cases. The position identifies and coordinates opportunities for Continuous Quality Improvement projects as well as provider profiling, benchmarking, and provider education.

Providence Health Plan welcomes Hybrid work for applicants who reside in the greater Portland, OR area.  You will be expected to work onsite at our offices in Portland or on client sites in the Portland area occasionally. 

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. 

Required qualifications:

• Graduate from an accredited School of Nursing.
• Upon hire: Oregon Registered Nurse License
• 5 years of Clinical experience.
• 2 years of Utilization review or quality assurance experience.
• Strong clinical background in orthopedics, neurology and rehabilitation.
• Documented experience as team or project leader.
• Experience in medical literature search and analysis.
• Experience in provider profiling and data analysis.
• Experience in personal computer applications, database management, spread sheets, and word processing.

Preferred qualifications:

• Bachelor's Degree Or Master's Degree in Nursing.
• 2 years of Medical case management.
• 2 years of experience in managed care or in workers' compensation insurance.

Why Join Providence Health Plan?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.  We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. 

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available f