MANAGER-SHP CARE COORDINATION

Company: Samaritan Health Services
Location: Corvallis
Posted on: October 7, 2024

Job Description:

• We are open to remote out of state work in any of our approved states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin.
• JOB SUMMARY/PURPOSE
  
  • Responsible for the execution and implementation of the Clinical Programs' strategy and goals, and the oversight of Clinical Programs' operations within Care Coordination. Oversees the effective integration and continuous improvement of processes and systems to meet Samaritan Health Plan current and future business goals. Manages and develops a team of clinical and support staff promoting their professional growth and operational effectiveness. Assures the development and maintenance of the infrastructure and procedures in cooperation with functional areas to promote the optimal performance of Medicaid, DSNP, SNP Model of Care, Medicare Advantage and Commercial Members. Identifies medical management initiatives, develops strategies, and deploys resources to reach corporate goals. Assists in evaluating the impact and effectiveness of initiatives. Works closely with health plan clinical team to prioritize projects, identify medical trends, and develop processes to successfully respond to trends.
  • DEPARTMENT DESCRIPTION
    
    • Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
    • EXPERIENCE/EDUCATION/QUALIFICATIONS
      
      • Current unencumbered Oregon RN License required within 90 days of hire. BSN preferred. Master's degree in a related field preferred.
      • Five (5) years care management experience that included three (3) years leadership experience required.
      • Experience in the following required:
        
        • Data analytics, project management and process design.
        • Health care delivery systems and/or managed care patients.
        • Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
        • Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
        • Case Management Certification (CCM) or Utilization Management Certification (MCG) preferred.
        • KNOWLEDGE/SKILLS/ABILITIES
          
          • Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
          • Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
          • Critical thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
          • Communication and team building - Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
          • PHYSICAL DEMANDS
            
            • Rarely
              (1 - 10% of the time)
              
              Occasionally
              (11 - 33% of the time)
              
              Frequently
              (34 - 66% of the time)
              
              Continually
              (67 - 100% of the time)
              
              CLIMB - STAIRS
              
              LIFT (Floor to Waist: 0-36) 0 - 20 Lbs
              
              LIFT (Knee to chest: 24-54) 0 - 20 Lbs
              
              LIFT (Waist to Eye: up to 54) 0 - 20 Lbs
              
              CARRY 1-handed, 0 - 20 pounds
              
              BEND FORWARD at waist
              
              KNEEL (on knees)
              
              STAND
              
              WALK - LEVEL SURFACE
              
              ROTATE TRUNK Standing
              
              REACH - Upward
              
              PUSH (0 - 20 pounds force)
              
              PULL (0 - 20 pounds force)
              
              SIT
              
              CARRY 2-handed, 0 - 20 pounds
              
              ROTATE TRUNK Sitting
              
              REACH - Forward
              
              MANUAL DEXTERITY Hands/wrists
              
              FINGER DEXTERITY
              
              PINCH Fingers
              
              GRASP Hand/Fist

Keywords: Samaritan Health Services, Gresham , MANAGER-SHP CARE COORDINATION, Executive , Corvallis, Oregon