Behavioral Health Care Mgr II

Samaritan Health Services Corvallis , OR 97333

Posted 2 months ago

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 Master#s degree in Mental Health, Social Work, Clinical Psychology or a closely related field required. Current unencumbered Oregon licensure in one (1) of the following required: Licensed Clinical Social Worker (LCSW). Clinical Social Work Associate (CSWA). Licensed Master of Social Work (LMSW). Licensed Professional Counselor (LPC). Licensed Psychologist (PhD or PsyD). Three (3) years behavioral health experience required. National Case Management Certification (CCM) required within 1 year of hire. Experience and/or training in the following required: Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Electronic medical information systems and documentation. Team leadership. 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) Occasionally (11 - 33% of the time) Frequently (34 - 66% of the time) Continually (67 # 100% of the time) CLIMB - STAIRS KNEEL (on knees) SQUAT Static (hold #30 sec) # LIFT (Floor to Waist: 0#-36#) 40 - 60 Lbs # # # SIT ROTATE TRUNK Sitting REACH - Upward CARRY 2-handed, 20 - 40 pounds LIFT (Floor to Waist: 0#-36#) 20 - 40 Lbs # # STAND WALK # LEVEL SURFACE 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 LIFT (Overhead: 54# and above) 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds CARRY 2-handed, 0 - 20 pounds BEND FORWARD at waist ROTATE TRUNK Standing REACH - Forward PUSH (0 - 20 pounds force) PULL (0 - 20 pounds force) MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist

  • 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

  • Master's degree in Mental Health, Social Work, Clinical Psychology or a closely related field required.

  • Current unencumbered Oregon licensure in one (1) of the following required:

  • Licensed Clinical Social Worker (LCSW).

  • Clinical Social Work Associate (CSWA).

  • Licensed Master of Social Work (LMSW).

  • Licensed Professional Counselor (LPC).

  • Licensed Psychologist (PhD or PsyD).

  • Three (3) years behavioral health experience required.

  • National Case Management Certification (CCM) required within 1 year of hire.

  • Experience and/or training in the following required:

  • Medicare and Medicaid rules and regulations and health plan benefit structure and policy.

  • Electronic medical information systems and documentation.

  • Team leadership.

  • 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)

Occasionally

(11 - 33% of the time)

Frequently

(34 - 66% of the time)

Continually

(67 - 100% of the time)

CLIMB - STAIRS

KNEEL (on knees)

SQUAT Static (hold >30 sec)

  • LIFT (Floor to Waist: 0"-36") 40 - 60 Lbs

SIT

ROTATE TRUNK Sitting

REACH - Upward

CARRY 2-handed, 20 - 40 pounds

LIFT (Floor to Waist: 0"-36") 20 - 40 Lbs

STAND

WALK - LEVEL SURFACE

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

LIFT (Overhead: 54" and above) 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

CARRY 2-handed, 0 - 20 pounds

BEND FORWARD at waist

ROTATE TRUNK Standing

REACH - Forward

PUSH (0 - 20 pounds force)

PULL (0 - 20 pounds force)

MANUAL DEXTERITY Hands/wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand/Fist

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Behavioral Health Care Mgr II

Samaritan Health Services