Director-SHS Utilization Management-Case Mgmt

Director-SHS Utilization Management-Case Mgmt

This is a hybrid position. Interested candidates must be available to work onsite as needed in Corvallis, Oregon.

JOB SUMMARY / PURPOSE

Responsible for overseeing and coordinating case management and utilization review activities across the healthcare system. Ensures that the clinical and operational processes related to case management and utilization review align with industry leading practices, regulatory standards, and organizational goals. Collaborates with interdisciplinary teams to improve patient care, streamline resource use, and maintain cost-efficiency while adhering to all relevant healthcare regulations.

DEPARTMENT DESCRIPTION

Utilization Management, Case Management and Social Services are an integral part of the multidisciplinary team, working closely with doctors, nurses, and other medical professionals. Utilization Management includes physician advisors, utilization review nurses and specialists that perform admission and continued stay compliance reviews for all Samaritan Hospitals. They are trained in Medicare and commercial insurance regulations, perform reviews on all admitted patients, provide staff and physician education, and communicate with insurance companies to assure payment of hospital services. The Case Management and Social Services teams provide direct services to screen and assess patients (“clients”) to facilitate discharge planning and care coordination, impart information and makes referrals, and intervene in crisis situations in their area of practice.

EXPERIENCE / EDUCATION / QUALIFICATIONS

Bachelor’s degree required. Master’s degree preferred.

Current unencumbered Oregon RN license required.

Five (5) years leadership experience in acute hospital case management and / or utilization review required.

Experience in Milliman (MGG) or InterQual required.

Accredited Case Manager (ACM) required within one (1) year of hire.

MCG Care Guidelines Specialist Certification – BHC required within six (6) months of hire.

KNOWLEDGE / SKILLS / ABILITIES

Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.

Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.

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.

Communication and team building – Leads effectively with excellent verbal and written communication. Delegates and initiates / manages cross-functional teams and multi-disciplinary projects.

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

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

PUSH (0-20 pounds force)

PULL (0-20 pounds force)

STAND

WALK – LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

SIT

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands / wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand / Fist

None specified

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