Job description

• JOB SUMMARY/PURPOSEManages 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 DESCRIPTIONSamaritan 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.

Fulltime/Permanent Jobs

Shift Information: Days, Full Time

Best Regards,

Vishal Kr.,

Cell No: 281-809-6173

Healthcare Recruiter

Job Types: Full-time, PRN

Pay: $87,000.00 - $131,000.00 per year

Benefits:

• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift

Experience:

• Utilization review: 1 year (Preferred)

License/Certification:

• RN (Preferred)

Work Location: One location

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