Travel Nurse RN - Case Management
Portland, OR
Prime Staffing
5x8 hrs, Days

We are seeking an experienced Health Plan Care Manager RN to provide comprehensive care management and coordination for health-plan members. This role focuses on improving continuity and quality of care while supporting appropriate healthcare utilization, care planning, utilization management, case management, and transitions across inpatient and outpatient settings.

The Care Manager will work closely with members, providers, hospitals, and internal teams to help members navigate their healthcare journey, understand their care plans, and connect with appropriate services and resources.
 

Assignment Details

• Position: RN – Health Plan Care Manager
• Location: Portland, OR – Onsite
• Schedule: Monday–Friday
• Hours: 40 hours per week
• Shift: Day Shift
• Work Setting: Health Plan / Care Management
• RN License: Required

Key Responsibilities

• Manage assigned health-plan members through comprehensive care management.
• Assess members' medical, psychosocial, functional, and healthcare needs.
• Develop, implement, and evaluate individualized care plans.
• Coordinate care across inpatient, outpatient, and ancillary healthcare settings.
• Promote continuity of care and appropriate transitions between healthcare settings.
• Perform utilization management and utilization review activities as appropriate.
• Evaluate medical necessity, level of care, services, and healthcare utilization.
• Collaborate with physicians, hospitals, providers, specialists, and interdisciplinary teams.
• Identify gaps in care and coordinate appropriate services and resources.
• Support members with discharge planning and post-discharge follow-up.
• Coach and educate members regarding their conditions, treatment plans, medications, appointments, and available healthcare resources.
• Help members navigate the healthcare system and overcome barriers to receiving appropriate care.
• Promote cost-effective care while maintaining quality and member-centered outcomes.
• Document assessments, care plans, interventions, and follow-up activities accurately and timely.
• Work collaboratively with internal health-plan teams and external providers to support positive member outcomes.

Required Qualifications

• Active Registered Nurse (RN) license in the state of practice.
• Strong clinical nursing background.
• Experience in acute care and/or multiple healthcare settings.
• Strong communication, coordination, and patient/member education skills.
• Ability to coach and guide members throughout their healthcare journey.
• Experience with case management, care coordination, utilization management, or utilization review is highly relevant.

Preferred Qualifications

• 5–10 years of nursing experience, particularly across acute and ancillary healthcare settings.
• Previous experience working for a health plan.
• Experience with Utilization Management and Case Management.
• BSN preferred.
• Certified Case Manager (CCM) preferred.
• Experience with medical-necessity criteria such as InterQual or MCG is beneficial.
• Experience with inpatient and outpatient care coordination and transitions of care.