Clinical Care Manager I - RN (Hybrid)

Serves as a single entry or "easy access" point to help members and providers navigate through managed care. Applies knowledge of applicable regulations, identifies resources (internal or community partners) and eliminates barriers where possible. Provides care management interventions and seamless support across transitions of care.

• This is a hybrid position that will consist of remote and onsite work in Corvallis, OR.
• 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.

• Associate's degree in a health care related field required. BSN preferred.
• Three (3) years nursing experience required.
• Experience and / or training in the following required :

Health care delivery systems and / or managed care patients.

• Computer applications including electronic documentation.
• Experience in the following preferred :

Medicare and Medicaid rules and regulations and health plan benefit structure and policy.

• KNOWLEDGE / SKILLS / ABILITIES

Communication - Effective written and verbal communication skills provided to members, providers and organization staff. Able to tactfully discuss issues, and listen to and understand complex information / situations. Ability to apply motivational interview techniques when working with members. Proactively resolve conflicts in positive and constructive manner.

• Confidentiality - Knowledge of State and Federal (HIPAA) laws pertaining to confidentiality of protected health information. Ability to comply with laws and maintain confidentiality of patient information.
• 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 in a member centric manner.
• Social Perceptiveness - Ability to work with a diverse population from pediatrics to geriatrics. Basic understanding of age-related differences in caring for and / or communicating with members and caregivers. Possess personal sensitivity to the needs and experiences of others and a non-judgmental attitude towards persons of differing standards, values, lifestyles, and ages.
• Knowledge of Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Ability to appropriately apply evidence based clinical practice and criteria to authorization requests.
• 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)

CARRY 2-handed, 0 - 20 pounds

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands / wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand / Fist

PI261223813