- Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members.
- JOB SUMMARY/PURPOSE
- Responsible for the centralization and coordination of the HRSN (health-related social needs) benefit while maintaining a customer-oriented approach. Ensures that the HRSN benefit process is easily accessible and utilized by internal and external stakeholders. Provides support to health plan members and providers and serves as a resource for care coordination while processing HRSN requests and inquiries.
- DEPARTMENT DESCRIPTION
- Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health 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; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.
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. - EXPERIENCE/EDUCATION/QUALIFICATIONS
- Current unencumbered Oregon RN License required. BSN preferred. Master's degree in a related field preferred.
- One (1) year clinical experience plus two (2) years case management and/or utilization management experience required.
- Health care delivery systems and/or managed care patients.
- Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
- Case Management Certification (CCM) or Utilization Management Certification (MCG) required within two (2) years of hire.
- Team leadership.
- Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
- KNOWLEDGE/SKILLS/ABILITIES
- Knowledge of social determinants of health (SDoH) and the relationship to the member's overall wellbeing.
- Knowledge of HRSN benefit, managed care principles, OHA requirements and OHP benefits and ability to incorporate this information into the HRSN coordination process.
- Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services and evaluation of customer service satisfaction.
- Ability to work, function and communicate on a multi-disciplinary team. Possess the knowledge and skills to develop constructive and cooperative working relationships with others and maintain them over time. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
- Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions respond quickly and appropriately.
- Ability to organize, plan and prioritize work to complete within required time frames and to follow-up on pending issues.
- Knowledge of medical terminology, ICD, CPT, and HCPCS codes.
- Strong communication skills (telephone skills with members, CBOs, interdepartmental communication).
- PHYSICAL DEMANDS
- Rarely
- LIFT (Floor to Waist: Lbs
-
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health-related social needs - Corvallis, OR , USA, United States - Samaritan Health Services
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; SHP is also the third-party administrator for Samaritan Health Services# self-funded employee health benefit plan.
#
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, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin # JOB SUMMARY/PURPOSE Responsible for the centralization and coordination of the HRSN (health-related social needs) benefit while maintaining a customer-oriented approach. Ensures that the HRSN benefit process is easily accessible and utilized by internal and external stakeholders. Provides support to health plan members and providers and serves as a resource for care coordination while processing HRSN requests and inquiries.
DEPARTMENT DESCRIPTION Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures:
InterCommunity Health 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; SHP is also the third-party administrator for Samaritan Health Services# self-funded employee health benefit plan.
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.
EXPERIENCE/EDUCATION/QUALIFICATIONS Current unencumbered Oregon RN License required. BSN preferred. Master#s degree in a related field preferred. One (1) year clinical experience plus two (2) years case management and/or 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). Case Management Certification (CCM) or Utilization Management Certification (MCG) required within two (2) years of hire.
Experience in the following preferred:
# Team leadership. Medicare and Medicaid rules and regulations and health plan benefit structure and policy. KNOWLEDGE/SKILLS/ABILITIES Knowledge of social determinants of health (SDoH) and the relationship to the member#s overall wellbeing. Knowledge of HRSN benefit, managed care principles, OHA requirements and OHP benefits and ability to incorporate this information into the HRSN coordination process. Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services and evaluation of customer service satisfaction. Ability to work, function and communicate on a multi-disciplinary team. Possess the knowledge and skills to develop constructive and cooperative working relationships with others and maintain them over time. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities. Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions respond quickly and appropriately. Ability to organize, plan and prioritize work to complete within required time frames and to follow-up on pending issues. Knowledge of medical terminology, ICD, CPT, and HCPCS codes. Strong communication skills (telephone skills with members, CBOs, interdepartmental communication). PHYSICAL DEMANDS Rarely % of the time) Occasionally % of the time) Frequently % of the time) Continually (67 # 100% of the time) CLIMB - STAIRS KNEEL (on knees) SQUAT Static (hold #30 sec) # LIFT (Floor to Waist: 0#-36# Lbs # # #
SIT ROTATE TRUNK Sitting REACH - Upward CARRY 2-handed, pounds LIFT (Floor to Waist: 0#-36# Lbs # #
STAND WALK # LEVEL SURFACE LIFT (Floor to Waist: 0#-36# Lbs LIFT (Knee to chest: 24#-54#) 0 # 20 Lbs LIFT (Waist to Eye:
up to 54# Lbs LIFT (Overhead: 54# and above Lbs CARRY 1-handed, pounds CARRY 2-handed, pounds BEND FORWARD at waist ROTATE TRUNK Standing REACH - Forward PUSH pounds force) PULL pounds force) MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist
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; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.
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.
Occasionally
% of the time)
Frequently
% of the time)
Continually
% of the time)
CLIMB - STAIRS
KNEEL (on knees)
SQUAT Static (hold >30 sec)
SIT
ROTATE TRUNK Sitting
REACH - Upward
CARRY 2-handed, pounds
LIFT (Floor to Waist:
Lbs
STAND
WALK - LEVEL SURFACE
LIFT (Floor to Waist:
Lbs
LIFT (Knee to chest:
Lbs
LIFT (Waist to Eye:
up to Lbs
LIFT (Overhead: 54 and above Lbs
CARRY 1-handed, pounds
CARRY 2-handed, pounds
BEND FORWARD at waist
ROTATE TRUNK Standing
REACH - Forward
PUSH pounds force)
PULL pounds force)
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
