This is a hybrid opportunity and will require time onsite.
JOB SUMMARY/PURPOSE
Serves as a single entry or "easy access" point to help members and providers navigate through managed care. 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.
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.
Associate's degree in a health care related field required. BSN preferred.
Three (3) years nursing experience required.
Experience and/or training in the following required:
Health care delivery systems and/or managed care patients.
Computer applications including electronic documentation.
Experience in the following preferred:
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.
Please Note :
ajayjain.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, ajayjain.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.
JOB SUMMARY/PURPOSE
Serves as a single entry or "easy access" point to help members and providers navigate through managed care. 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.
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.
Associate's degree in a health care related field required. BSN preferred.
Three (3) years nursing experience required.
Experience and/or training in the following required:
Health care delivery systems and/or managed care patients.
Computer applications including electronic documentation.
Experience in the following preferred:
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.
Please Note :
ajayjain.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, ajayjain.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.