This team is looking for candidates with a qualifying unrestricted RN license in the State of Oregon, Idaho, Montana, or Georgia. Candidates must be located in Oregon, Idaho, Montana, or Georgia in order to be considered.
Qualified candidates must be acceptable to the following available work schedule:
The Manager of Utilization Management (UM) for Inpatient, Post-Acute and Dual Eligible Special Needs (DSN oversees and directs the utilization management process for inpatient admissions, post-acute care services, and DSNP members). This role ensures compliance with regulatory requirements, optimizes quality and cost-effectiveness, and facilitates coordinated care across the care continuum. The Manager works closely with interdisciplinary teams to achieve organizational goals and high standards of member-centric care and is integrally involved in the Health Services (HS) program development, implementation, and strategic planning.
Essential Responsibilities:
Supporting Responsibilities:
SUCCESS PROFILE
Work Experience: Minimum of seven (7) years of clinical experience required and a minimum of 3 years direct health plan experience in case management, utilization management, or disease management. Prior supervisory or management experience required.
Education, Certificates, Licenses: Registered Nurse or Licensed Clinical Social Worker with current appropriate state licenses. Certified Case Manager Certification as accredited by CCMC preferred.
Knowledge: Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes, including ICD-9 & 10, CPT codes, health insurance and State of Oregon mandated benefits. Knowledge of managed care products and third-party liability (TPL) is required. Ability to develop, review and evaluate utilization and case management reports. Knowledge of health insurance and State mandated benefits experience in adult education preferred.
Competencies
Building Trust
Building a Successful Team
Aligning Performance for Success
Building Partnerships
Customer Focus
Continuous Improvement
Decision Making
Facilitating Change
Leveraging Diversity
Driving for Results
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Skills:
Accountable leadership, Collaboration, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic Thinking
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.
PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
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