Utilization Management Program Manager-RN

JOB SUMMARY/PURPOSE

Executes program(s) that meet the needs of the organization, employees and/or customers. Plans, initiates, oversees execution of all elements for assigned program(s). Leads the development, implementation and management of assigned program(s) and associated projects. Oversees process from planning to completion. Works with multiple internal teams, vendors, clients. Responsible for explaining, training, and mentoring the entire organization on the program. Collaborates with SHS system experts to ensure focus, alignment, and best practices for the program.

EXPERIENCE/EDUCATION/QUALIFICATIONS

• Current unencumbered Oregon RN License required within 90 days of hire. BSN preferred. Master's degree in a related field preferred.
• One (1) year clinical nursing experience plus four (4) years health plan utilization management experience required.
• Experience or training in the following required:
  • Health care delivery systems and/or managed care patients.
  • Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).

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 – Lead effectively with excellent verbal and written communication. Delegates and initiates/manage 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
• BEND FORWARD at waist
• KNEEL (on knees)
• STAND WALK – LEVEL SURFACE
• ROTATE TRUNK
• SIT
• CARRY 2-handed, 0 - 20 pounds
• ROTATE TRUNK Sitting
• REACH - Upward
• PUSH (0 - 20 pounds force)
• PULL (0 - 20 pounds force)