Manager-Utilization Mgmt-SHP - Samhealth Test account

• JOB SUMMARY/PURPOSE
  • Manages medical management projects and initiatives related to case management, utilization management, ENCC and clinical pharmacy. Identifies medical management initiatives, develops strategies and deploys resources in order to reach corporate goals. Assists in evaluating the impact and effectiveness of initiatives. Works closely with health plan medical management 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
  • Bachelor's degree required.
  • Current unencumbered Oregon RN license required.
  • Four (4) years experience in program or project management required. The experience must have included program evaluation responsibility.
  • Four (4) years supervisory experience required.
  • Experience or training in the following required:
    • Disease management, utilization management, case management, clinical pharmacy and managed care.
    • Data analysis, problem-solving processes and communication strategies.
    • Computer applications.
  • Previous health plan experience preferred.
  • Experience or training in Medicare, Medicaid and commercial insurance 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)

    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
    

    CARRY 2-handed, 0 - 20 pounds
    

    KNEEL (on knees)
    

    BEND FORWARD at waist
    

    CLIMB - STAIRS

    STAND
    

    WALK - LEVEL SURFACE
    

    ROTATE TRUNK Standing
    

    REACH - Upward
    

    PUSH (0-20 pounds force)
    

    PULL (0-20 pounds force)

    SIT
    

    ROTATE TRUNK Sitting
    

    REACH - Forward
    

    MANUAL DEXTERITY Hands/wrists
    

    FINGER DEXTERITY
    

    PINCH Fingers
    

    GRASP Hand/Fist

    None specified

PI250825802