Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.In partnership with the Health-Related Social Needs (HRSN) Program Manager, develop an HRSN program that will meet or exceed OHA requirements, promote positive member outcomes, improve community health, and serve members consistent with PacificSource’s values. The three components of HRSN include climate supports, housing assistance, and food/nutrition. Manage the daily operations, including oversight/supervision of the HRSN team, which may include the following team members: Health Services Representatives (HSR), Member Support Specialists (MSS), and Clinicians. Integrally involved in, and accountable, for HRSN program development and performance internal measures. as well as those established by regulatory entities. Key participant in Health Services (HS) strategy, program development and implementation.Essential Responsibilities:
Work closely with the Director, HRSN Program Manager, and other Managers in Utilization Management (UM) and Case Management (CM), to facilitate the development and implementation of new programs and processes to support ongoing success of department goals and initiatives, including but not limited to ongoing activities related to HRSN and the development of a cohesive multi-team approach.
Collaborate with organizational subject matter experts to develop strategies and payment methodologies, including closed-loop referral pathways, to pay entities that deliver HRSN benefits.
Leverages use of evidence-based best practice.
Responsible for oversight, management, development, implementation, and communication of department programs.
Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.
Responsible for oversight, management, development, implementation, and communication of department programs.
Ensure PacificSource UM programs are communicated to and coordinated with our provider and community partners.
Foster effective teamwork and performance.
Manage change and encourage innovation.
Build collaborative relationships, encourage involvement and initiative, and develop goal orientation in others.
Take an active leadership role in initiation and implementation of departmental process/performance improvement activities.
Responsible for process improvement and working with other departments to improve interdepartmental processes.
Utilize LEAN methodologies for continuous improvement.
Utilize visual boards and frequent huddles to monitor key performance indicators and identify improvement opportunities.
Coordinate business activities by maintaining collaborative partnerships with key departments.
Actively participate as a key team member in Manager/Supervisor meetings.
Actively participate in various strategic and internal committees to disseminate information within the organization and represent company philosophy.
Supporting Responsibilities:
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.
SUCCESS PROFILEWork Experience: Seven (7) years clinical experience required. A minimum of 3 years direct health plan experience in case management, utilization management, or disease management, or equivalent preferred. Prior supervisory or management experience required.Education, Certificates, Licenses: Licensed Clinical Social Worker or Registered Nurse, with current appropriate state licenses. Bachelor’s degree in nursing, preferred.Knowledge: Thorough knowledge and understanding of medical and behavioral health procedures, diagnoses, and treatment modalities, procedure codes, including ICD-9 & 10, DSM-IV & V, CPT codes, health insurance and State of Oregon mandated benefits. Familiarity with Oregon Health Authority’s regulatory requirement, including the HRSN components of the 1115 Waiver. Knowledge of community services, providers, vendors, and facilities available to assist members. Strong knowledge of health insurance; including managed care products as well as state mandated benefits. Proficiency in Microsoft Office, including Word, Outlook, PowerPoint, and Excel. Ability to analyze data, create applicable reporting and establish metrics. Proficient in the use and implementation of the following tools and concepts across all teams within scope and accountability: Training, Coaching, Strategy Deployment, Daily Operations, Visual Management, Operational Improvement & Team Building/Development.CompetenciesBuilding TrustBuilding a Successful TeamAligning Performance for SuccessBuilding PartnershipsCustomer FocusContinuous ImprovementDecision MakingFacilitating ChangeLeveraging DiversityDriving for ResultsEnvironment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.Skills: Accountable leadership, Collaboration, Data-driven & Analytical, Delegation, Effective communication, Listening (active), Situational Leadership, Strategic ThinkingOur ValuesWe live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
