Program Manager-RN

• 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.

• Under the general direction of the director of Quality, the program manager for the Parent/Maternal and Child Health program will lead our maternal/high risk pregnancy program in delivering a person and family centered, culturally humble services to support a healthy pregnancy and baby.

• This role is also responsible for coordinating with external and internal stakeholders to ensure compliance with established policies, objectives, program priorities, CCO metrics and all applicable laws and regulations as appropriate.

EXPERIENCE/EDUCATION/QUALIFICATIONS - Current unencumbered Oregon RN License required within 90 days of hire. BSN preferred. Master's degree in a related field preferred. - One (1) year clinical nursing experience plus four (4) years health plan, 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). - Experience in the following preferred: - Team leadership. - Case management. - Medicare and Medicaid rules and regulations and health plan benefit structure and policy.

KNOWLEDGE/SKILLS/ABILITIES - Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management. - Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner. - Critical thinking – Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions. - Communication and team building – Lead effectively with excellent verbal and written communication. Delegates and initiates/manage cross-functional teams and multi-disciplinary projects.