Providence Health & Services Supervisor, HCS Medical Management in Beaverton, Oregon
Providence St. Joseph Health is calling a Supervisor-HCS Medical Management to our location in Beaverton, OR.
We are seeking a HCS Medical Management Supervisor that is responsible for providing day to day oversight for the general operations of the Care Management and Medical Review teams within Health Care Services (HCS) and works in cooperation with the Manager to provide leadership and guidance for HCS staff. In addition to supervisory responsibilities, duties include all functions of Care Management daily operations including providing case management or medical review, coordination and assistance to patients with complex health needs or the potential for poor health outcomes.
Acts as a mentor and role model; problem solving day to day issues and promotes team building that reflects the Providence mission and core values.
In this position you will have the following responsibilities:
Oversee the daily activities of staff, including hiring and performance management.
Perform the six essential activities of case management: assessment, coordination, planning, monitoring, implementation and evaluation in multiple environments.
Perform case and utilization management of chronic and catastrophic cases to effectively manage services, benefits, costs and quality following HCS policies and procedures.
Provide case and utilization management for specialty programs as required by commercial and government contracts or product design.
Develop and maintain positive relationships with providers and facilities to facilitate case and utilization management; maintain knowledge in subject matter and enhance Health Plan expertise in the area of case and utilization management.
Track and report department activities, savings and outcomes as appropriate for the individual program.
Foster professional relationships with peers and collaborates across HCS and PHP departments.
Screen members identified through Health Risk assessments as high cost/complex for potential case management.
Required qualifications for this position include:
Graduated from an accredited school of nursing or equivalent clinical program (i.e.: Council on Social Work Education).
Clinical license in good standing in the state of Oregon; as applicable.
Minimum of 5 years of clinical experience.
Experience with managed care services including population health initiatives, Affordable Care Act, Coordinated Care Organizations, Accountable Care Organizations, Medicare and Medicaid regulations.
Current driver’s license.
Certifications in Areas of Expertise: Certified Coder, Certified Case Manager, Certification in Utilization Management.
Preferred qualifications for this position include:
Bachelor Degree in Nursing or other Clinical degree. Advanced degree, LCSW, if applicable. Applicable work experience may be substituted for some education.
Previous supervisory or lead experience.
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: Nurse Lead/Supervisor/Manager
Req ID: 241323