Providence Health & Services Healthcare Services Manager in Beaverton, Oregon
Providence St. Joseph Health is calling a Healthcare Services Manager to our location in Beaverton, OR.
This position is responsible for Management and supervision of the PHP Utilization Management (UM) or Care Management (CM) clinical programs, outcomes and operations. In addition, this person will be responsible for collaboration and coordination of all UM or CM programs with key Oregon and System leadership throughout Providence St. Joseph's Health.
The Health Care Services (HCS) Manager will coordinate, manage, and direct clinical programs and department operations. The HCS Manager will also develop, analyze and provide consultation on UM or CM outcomes. This position will have direct reports that include supervisors, program managers, registered nurses, social workers, clinical support coordinators, technicians and may include other support staff as needed.
In this position you will have the following responsibilities:
•Manage the operations and support team within Health Care Services including the Call Center, Utilization Management or Care Management intake & review functions which includes but is not limited to prior authorization, concurrent review (CCR), Claims, skilled nursing facility (SNF) Review and care management services.
•Provide oversight and direction for systems and tools used internally by staff and externally by provider partners to assist in Medical or Care Management operations.
•Achieves organizational performance standards for Call Center activities, prior authorization, CCR review, SNF review, Claims Audit, Care Management and other areas as deemed appropriate.
•Prepares and manages budget for applicable area(s).
•Manages coordination of all work, quality improvement activities, projects, objectives and staffing of the department by working with other Managers and Supervisors within Health Care Services.
•Evaluates performance and initiates personnel actions such as hiring, merit increases, probationary and periodic reviews, promotions, work plans and disciplinary actions.
•Collaborates across Health Care Services departments to assure cross-functional workflow integration in all dependent areas.
•Establishes and sustains open and transparent communication across divisions and departments within Health Care Services as well as PHP.
•Ensures responsible areas are compliant with all service level agreements, regulatory requirements, contractual requirements and accreditation bodies and that policies & procedures accurately reflect the current guidance and regulations.
•Establishes and maintains quantitative and qualitative performance standards and workload metrics for caregivers in addition to tracking and providing timely reports for caregivers and leadership as needed.
•Works with peers on new products, benefit changes, and new lines of business in order to establish service team coverage as well as the necessary system changes.
•Routinely reviews and re-engineers operations through continuous quality improvement as needed to meet demands.
•Health Care Services Expert, ability to deliver affordable healthcare by applying stratification and impactful interventions; combining medical management, care management, community partners, delivery systems, and regulatory requirements to meet the needs of our population.
Required qualifications for this position include:
Bachelor’s degree in Nursing or other clinical bachelor degree equivalent.
Currently licensed as a registered nurse in good standing in Oregon or current equivalent clinical license.
Graduate from an accredited school of nursing or graduate from an accredited equivalent clinical program.
3 years of documented direct management or supervisory experience in a clinical or managed care setting.
5 years of clinical experience.
2 years of utilization, quality or care management experience in an insurance or managed care setting.
Proven knowledge of the management, operation, function and objectives of population based utilization and care management services for individual patients/members.
Strong project management skills with the ability to coordinate complex projects and build work plans to lead a group through implementation and execution of new projects and continuous process improvement projects.
Strong working knowledge of all pertinent regulatory and accrediting body requirements, specifically CMS, State Medicaid Programs, The Affordable Care Act and NCQA.
Working knowledge of CPT, HCPCS and ICD-9 & ICD-10 coding.
Demonstrated working knowledge of health care cost containment concepts and managed care principles.
Knowledge of medical benefits and medical/transplant network administration.
Knowledge of confidentiality guidelines.
Preferred qualifications for this position include:
Master’s degree in Nursing, or related field.
Certification in case management, utilization management or quality improvement.
Project management, Six Sigma, Lean, Change Acceleration Process (CAP) experience or certification.
Experience with HEDIS, CAHPS, Medicare 5-Star Rating, NCQA and/or URAC accreditation.
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.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Clinical Lead Supervisor/Manager
Req ID: 232562