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.
Samaritan Health Plans is an Insurance Company that creates and delivers products and services that help build healthier communities. As part of an Integrated Delivery System, Samaritan Health Plans believes in giving members a greater role in their health and employers more options for their employees.
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).
Licensed Psychologist (PhD or PsyD).
Five (5) years experience with behavioral health care delivery systems and/or managed care patients required.
Three (3) years utilization or case management 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.
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.
(1 - 10% of the time)
(11 - 33% of the time)
(34 - 66% of the time)
(67 – 100% of the time)
CLIMB - STAIRS
KNEEL (on knees)
SQUAT Static (hold >30 sec)
LIFT (Floor to Waist: 0"-36") 40 - 60 Lbs
ROTATE TRUNK Sitting
REACH - Upward
CARRY 2-handed, 20 - 40 pounds
LIFT (Floor to Waist: 0"-36") 20 - 40 Lbs
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