Health Related Services Manager
Company: CareOregon
Location: Portland
Posted on: May 28, 2023
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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
Exempt
Department
Clinical Operations
Manager Title
Director, Clinical Operations
Direct Reports
Health-Related Services Staff
Requisition #
23469
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
Required:
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
Preferred:
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
Knowledge
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.
#Li-Remote
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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