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INTRODUCTION

Benefit Management Operations Supervisor

This position is responsible for supervising daily benefit management operations and staff. Work includes implementing and monitoring processes and procedures that support Care Management program goals and organizational strategic objectives, as well as ensuring staff are performing at required competency and production levels. This position may perform the tasks of non-clinical Medical Management staff during times of coverage needs or reassignment of work.

Estimated Hiring Range:

$72,765.00 - $88,935.00

Bonus Target:

Bonus - SIP Target, 5% Annual

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

ESSENTIAL RESPONSIBILITIES

• Identify opportunities to improve the program’s effectiveness and efficiency of work processes.
• Implement, monitor and evaluate approved program changes.
• Keep abreast of Oregon Health Plan (OHP), Medical Assistance Program (MAP), and Medicare rules and regulations; inform manager, staff and other stakeholders of changes that impact decisions and practice.
• Ensure that services requests and authorizations are processed according to the (OHP) rules and regulations, Medicare regulations, and National and Local Coverage Determinations.
• Develop process documentation and training materials as needed.
• Provide orientation to new employees or provide oversight to staff who will provide the orientation.
• Provide on-going training to address programmatic and staff needs in all areas of utilization management functions.
• Make recommendations regarding the use of technologies that may enhance departmental performance and serve as a departmental resource for the implementation of any such technology.
• Keep current on system process and issues, including QNXT functions and SharePoint, including upgrades and upgrade testing.
• Act as a resource for staff and Medical Directors.
• Work with identified CareOregon staff and departments to find opportunities to support financial impact initiatives.
• Work collaboratively with other CareOregon departments.
• Ensure that CareOregon authorization decisions are based on coverage rules.

TEAM ASSIGNMENT/COVERAGE

• Remain informed about current processes and tasks performed by prior authorization, referral, appeal, claim review, and concurrent review staff.
• Stay current with work processes by providing periodic coverage for staff assignments.
• Work with staff to determine coverage in the event of unplanned absences.
• Cover an assignment when necessary.

EMPLOYEE SUPERVISION

• Supervise team and recommend team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensure team adheres to department and organizational standards, policies, and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with Human Resources as needed.

EXPERIENCE AND/OR EDUCATION

Required

• Minimum 2 years’ experience in practice management of primary or specialty care and/or Health Plan Operations that includes utilization review activity

Preferred

• Minimum 1 year experience in a supervisory or lead position or completion of CareOregon’s Aspiring Leaders Program; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks
• Utilization management experience

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

Knowledge

• Knowledge of utilization management practice principles and industry standard criteria
• Knowledge of Oregon Health Plan (OHP) benefit package including rules and regulations that pertain to health plan operations
• Knowledge of Oregon Medical Assistance Program (MAP)
• Knowledge of the Centers for Medicare and Medicaid Services (CMS) rules and regulations, including Medicare A and B benefits and regulations governing Medicare Advantage plans
• Knowledge of principles of managed care and utilization management
• Knowledge of ICD-9, CPT, HCPCS coding

Skills and Abilities

• Ability to work with the department, stakeholders or customers to effectively resolve issues
• Ability to use critical thinking skills in problem solving
• Ability to manage multiple tasks and to remain flexible in a dynamic work environment
• Ability to function autonomously and to effectively set priorities
• Ability to present a positive and professional image
• Ability to develop and implement processes and procedures
• Ability to provide effective leadership and supervision to groups of people
• Ability to read, write and verbally communicate effectively
• Excellent customer service skills
• Ability to use basic word processing, spreadsheet and database programs and the ability to learn more complex programs
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day

WORKING CONDITIONS

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.