Offer summary

Qualifications:

Current unencumbered Oregon RN License required; BSN preferred., One year of clinical nursing experience required., Experience in health care delivery systems and managed care patients is necessary., Familiarity with Medicare and Medicaid rules and regulations is strongly preferred..

Key responsabilities:

Assess, plan, implement, coordinate, monitor, and evaluate health services for individuals.

Provide care management interventions and support across transitions of care.

Work with cases that have a low to moderate level of service intensity.

Communicate effectively with members, providers, and organization staff to resolve issues.

Job 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.

Candidates residing out of state will need to be able to work Pacific Time Zone hours.

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, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

Occasionally

JOB SUMMARY/PURPOSE
Assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs. Applies knowledge of applicable regulations, identifies resources (internal or community partners) and eliminates barriers where possible. Provides care management interventions and seamless support across transitions of care. Works with cases that have a low to moderate level of service intensity.
EXPERIENCE/EDUCATION/QUALIFICATIONS
Current unencumbered Oregon RN License required. BSN preferred.
One (1) year clinical nursing 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 strongly preferred:

Case management.
Medicare and Medicaid rules and regulations and health plan benefit structure and policy.

KNOWLEDGE/SKILLS/ABILITIES
Communication - Effective written and verbal communication skills provided to members, providers and organization staff. Able to tactfully discuss issues, and listen to and understand complex information/situations. Ability to apply motivational interview techniques when working with members. Proactively resolve conflicts in positive and constructive manner.
Confidentiality - Knowledge of State and Federal (HIPAA) laws pertaining to confidentiality of protected health information. Ability to comply with laws and maintain confidentiality of patient information.
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 in a member centric manner.
Social Perceptiveness - Ability to work with a diverse population from pediatrics to geriatrics. Basic understanding of age-related differences in caring for and/or communicating with members and caregivers. Possess personal sensitivity to the needs and experiences of others and a non-judgmental attitude towards persons of differing standards, values, lifestyles, and ages.
Knowledge of Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Ability to appropriately apply evidence based clinical practice and criteria to authorization requests.
PHYSICAL DEMANDS
Rarely (1 - 10% of the time)

(11 - 33% of the time)

Frequently

(34 - 66% of the time)

Continually

(67 – 100% of the time)

CLIMB - STAIRS

LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

LIFT (Knee to chest: 24"-54") 0 – 20 Lbs

LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

BEND FORWARD at waist

KNEEL (on knees)

STAND

WALK – LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0 - 20 pounds force)

PULL (0 - 20 pounds force)

SIT

CARRY 2-handed, 0 - 20 pounds

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands/wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand/Fist

PI265330467

Required profile