Top 5 Utilization management program manager Jobs in Corvallis, Or

Utilization Management Program Manager-RN
Samaritan Health Services —Corvallis, OR
- $47.39 - $71.09 an hour
- Nursing
- RN License
- Mid-level
- Health insurance
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical Care —Lebanon, OR
- Full-time
- Nursing
- RN License
- Administrative experience
- Tuition reimbursement
Family Medicine Medical Director Utilization Management
Amerihealth Caritas —United States
- Weekends as needed
- Hybrid work
- Medicine
- Physical & Rehabilitation Medicine
- 3 years
- Paid holidays
- Health insurance
Inpatient Medical Coding Quality Auditor
Pena4 Inc. —United States
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- 5 years
- US work authorization
- Senior level
- Health insurance
- Dental insurance
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3d

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Utilization Management Program Manager-RN

Samaritan Health Services -
Corvallis, OR

Apply Now

Job Details

$47.39 - $71.09 an hour

Benefits

Health insurance

Qualifications

Nursing
RN License
Managed care organization experience
Patient management software
Microsoft Office
EMR/EHR
Utilization management
Resource utilization in healthcare
Nursing

Full Job Description

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth 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.

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.

This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

Our ideal candidate will have the following experience:
- Health plan utilization management
- Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
- Data analysis to include reporting results and developing improvement plans
- Quality Management experience in a healthcare setting
JOB SUMMARY/PURPOSE
- Executes program(s) that meet the needs of the organization, employees and/or customers. Plans, initiates, oversees execution of all elements for assigned program(s). Leads the development, implementation and management of assigned program(s) and associated projects. Oversees process from planning to completion. Works with multiple internal teams, vendors, clients. Responsible for explaining, training, and mentoring the entire organization on the program. Collaborates with SHS system experts to ensure focus, alignment, and best practices for the program.

EXPERIENCE/EDUCATION/QUALIFICATIONS
- Current unencumbered Oregon RN License required within 90 days of hire. BSN preferred. Master's degree in a related field preferred.
- One (1) year clinical nursing experience plus four (4) years health plan utilization management experience required.
- Experience or training in the following required:
  - Health care delivery systems and/or managed care patients.
  - Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
- Experience in the following preferred:
  - Team leadership.
  - Case management.
  - Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
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 – Lead effectively with excellent verbal and written communication. Delegates and initiates/manage 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)
  
  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)
  
  SIT
  
  CARRY 2-handed, 0 - 20 pounds
  ROTATE TRUNK Sitting
  
  REACH - Forward
  
  MANUAL DEXTERITY Hands/wrists
  
  FINGER DEXTERITY
  
  PINCH Fingers
  
  GRASP Hand/Fist

Location: Samaritan Health Services · SHS Health Plan Ops - Clin Ser
Schedule: 1.0 (80 hrs/pp), Day

Apply Now

Refine Your Search

utilization management program manager jobs in corvallis, or

Utilization Management Program Manager-RN

Dialysis Clinical Manager Registered Nurse - RN

Family Medicine Medical Director Utilization Management

Inpatient Medical Coding Quality Auditor

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