Providence St. Joseph Health is calling a Supervisor Health Care Services (HCS) Medical Management to our location in Beaverton, OR.
We are seeking a Supervisor Health Care Services (HCS) Medical Management to be responsible for providing day to day oversight for the general operations of the Care Management or Utilization Management teams within HCS and works in cooperation with the Manager to provide leadership and guidance in one or more of the following areas: care management, prior authorization, concurrent review, clinical claims audit and appeals. In addition to supervisory responsibilities, duties include all functions of HCS daily operations including providing case management or medical review, coordination and assistance to patients with complex health needs or the potential for poor health outcomes. Act as a mentor and role model; problem solving day to day issues and promotes team building that reflects the Providence mission and core values.
In this position you will have the following responsibilities:
- Oversee the daily activities of staff, including hiring and performance management.
- Perform case and utilization management of chronic and catastrophic cases to effectively manage services, benefits, costs and quality following HCS policies and procedures.
- Provide case and utilization management for specialty programs as required by commercial and government contracts or product design.
- Develop and maintain positive relationships with providers and facilities to facilitate case and utilization management; maintain knowledge in subject matter and enhance Health Plan expertise in the area of case and utilization management.
- Identify internal and external customers, determine customer needs and satisfy those needs.
- Assure that all responsibilities are performed consistent with the deliberate plans of the organization; maintain a sensitive, caring, and safe environment for customers, co-workers, providers, and others while operating within the limits of approved budgets.
Required qualifications for this position include:
- Graduation from an accredited school of nursing or graduation from an accredited clinical program (i.e.: Council on Social Work Education).
- Applicable work experience may be substituted for some education.
- 5 years Clinical experience.
- Experience with managed care services including population health initiatives, Affordable Care Act, Coordinated Care Organizations, Accountable Care Organizations, Medicare and Medicaid regulations.
- Experience with development of innovative and focused partnerships and programs which challenge the norm to support an ever changing healthcare environment.
- Experience in cost stewardship using Lean principles or other means which increase effectiveness and cut waste.
- Experience supporting teams with electronic processing systems.
- Proven track record of delivering process and fiscal improvements leading to increased efficiencies and overall savings.
- Experience in working with physicians in collaboration and management of patient care.
- Demonstrated experience in project management, educational program development and implementation, and technology.
- Current licensed driver.
Preferred qualifications for this position include:
- Bachelor's Degree Nursing or other Clinical degree.
- Advanced degree.
- Supervisory or lead experience.
- Clinical license in good standing in the state of Oregon; as applicable.
- LCSW, if applicable.
- Certifications in Areas of Expertise:
- Certified Coder.
- Certified Case Manager.
- Certification in Utilization Management.
About Providence in Oregon.
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, “Providence will provide the best care and service to every person, every time.“
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.