Manager-Utilization Mgmt-SHP

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)

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands / wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand / Fist

None specified

PI261218792