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Health Related Services Manager

Company: CareOregon
Location: Portland
Posted on: May 28, 2023

Job Description:

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, or Nevada.
Job Title
Health Related Services Manager
Exemption Status
Clinical Operations
Manager Title
Director, Clinical Operations
Direct Reports
Health-Related Services Staff
Requisition #
Pay and Benefits
Estimated hiring range $84,765 - $102,565, 5% bonus target, full benefits. To learn more about our benefits, please visit CareOregon - Employee benefits (https://www.careoregon.org/about-us/careers/benefits)
Job Summary
This position is responsible for development and management of CareOregon's health related services program. This includes implementation of program standards and procedures, monitoring program impact, and ensuring effectiveness and integrity. This position works closely with organizational leaders as well as community partners to ensure collaboration, integration and support of organizational goals and activities focused on promoting community health and well-being.
Essential Responsibilities
Operational Management

  • Provide operational and clinical leadership.

  • Develop and implement programs and services to ensure the use of CareOregon resources meet medical or social appropriateness this entails oversight of multimillion dollar costs of services.

  • Work collaboratively with department leaders to oversee program standards and procedures.

  • Monitor program impact and effectiveness on the health, experience, and cost of care for the membership and in relation to social determinants of heath.

  • Lead team in setting and fulfilling established goals and objectives.

  • Ensure policies and procedures meet CareOregon and current government agency contracting requirements (e.g., Oregon Health Authority, Division of Medical Assistance Program (DMAP), Centers for Medicare and Medicaid (CMS), etc.).

  • Ensure program compliance with applicable state and federal regulatory bodies that oversee health plan operations.

  • Ensure integration of work between program functional areas; promote effective communications within CareOregon and between external partners, providers, and members.

  • Consult with Medical Director(s) as appropriate for input on complex clinical cases and benefit management policies.

  • Act as a technical and operational resource to program supervisors.

  • Ensure unit work is performed in coordination with other relevant CareOregon departments; service as a liaison and collaborator with multiple teams including provider customer service, claims, appeals and grievances, population health, information systems, and others.

  • Keep current on standards for health plan operations related to utilization and case management.

  • Perform on-going analysis of data and information, looking for opportunities for improvement in appropriate utilization of resources.

  • Frequently communicate with providers and partners to problem solve issues and improve workflows.

  • Liaise with internal and external partners to ensure compliance with contracted reporting expectations.

  • Collaborate with IS on system performance, improvement, and functionality to maximize performance of multiple technology platforms and products, and to provide reporting to internal and external stakeholders.

    Program Development, Improvement, and Evaluation

    • Collaborate with department leadership for updates to policies and procedures.

    • Assist in regularly developing programmatic guidelines, and ensure these guidelines are followed.

    • Identify opportunities for improvement and participate in their development and implementation, including process improvement initiatives.

    • Develop, utilize, and regularly monitor measures/metrics to improve the program's effectiveness and efficiency of work processes.

    • Create a unit environment that encourages professionalism and teamwork and uses progressive problem solving to meet expectations.

      Employee Supervision

      • Manage team and recommend team direction and goals in alignment with the organizational mission, vision, and values.

      • Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.

      • Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.

      • Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.

      • Train, supervise, motivate, and coach employees; provide support toward employee development.

      • Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.

      • Ensure team adheres to department and organizational standards, policies, and procedures.

      • Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).

      • Perform supervisory tasks in collaboration with Human Resources as needed.
        Organizational Responsibilities

      • Perform work in alignment with the organization's mission, vision and values.

      • Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.

      • Strive to meet annual business goals in support of the organization's strategic goals.

      • Adhere to the organization's policies, procedures and other relevant compliance needs.

      • Perform other duties as needed.

        Experience and/or Education

        • Minimum 5 years' related experience included planning, development, and administration of health or social services at local community, county, or state level programs

        • Minimum 3 years' experience developing and supporting collaborative partnerships with multiple agencies (e.g., social service agencies, etc.)

        • Minimum 2 years' experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon's Aspiring Leaders Program


          • Experience administering Medicaid/Medicare physical or behavioral health benefits

          • Management or supervisory experience in managed care

          • Clinical licensure in related field

          • Experience with process improvement and project management

          • Health Plan experience
            Knowledge, Skills and Abilities Required


            • Advanced knowledge of managed care concepts and principles

            • Advanced knowledge of health plan regulatory requirements for Medicaid and Medicare managed care plans

            • Advanced knowledge of basic health plan operations

            • Advanced knowledge of utilization management concepts, principles, and practices

            • Advanced knowledge of care coordination and case management concepts, principles, and practices

            • Knowledge of organizational change principles and ability to act as a change agent

            • Knowledge of disease management and health promotion principles and processes

            • Knowledge of OHP benefits, DMAP, and/or CMS rules and regulations preferred

              Skills and Abilities

              • Excellent time management and organizational skills

              • Ability to manage multiple tasks, complex projects, and appropriately delegate

              • Ability to work well under pressure in a complex and rapidly changing environment

              • Excellent problem-solving and decision-making skills

              • Excellent reading, oral and written communication skills

              • Excellent interpersonal skills

              • Ability to effectively collaborate with the department's medical directors, leadership and staff, and other stakeholders/customers

              • Ability to negotiate skillfully and to build consensus

              • Ability to manage staff, including training and mentoring staff growth

              • Ability to develop and implement procedures and program standards

              • Ability to oversee services involving substantial costs

              • Ability to support and comply with organizational policies, procedures, and guidelines

              • Ability to effectively use Microsoft (Outlook, Word, Excel, SharePoint, etc.) and learn systems as needed

              • Ability to work effectively with diverse individuals and groups

              • Ability to learn, focus, understand, and evaluate information and determine appropriate actions

              • Ability to accept direction and feedback, as well as tolerate and manage stress

              • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day

              • Ability to hear and speak clearly for at least 3-6 hours/day

                Working Conditions
                Work Environment(s): --' Indoor/Office --- Community --- Facilities/Security --- Outdoor Exposure
                Member/Patient Facing: --' No --- Telephonic --- In Person
                Hazards: May include, but not limited to, physical and ergonomic hazards.

                Equipment: General office equipment
                Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
                Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment
                Veterans are strongly encouraged to apply.
                Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Keywords: CareOregon, Portland , Health Related Services Manager, Healthcare , Portland, Oregon

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