RN Clinical Benefit Management Supervisor

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🔥 2 minutes ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $126.7k - $154.9k / year

⏰ Full Time

🟢 Junior

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Supervise a remote team of RNs in Prior Authorization or Benefit Review • Oversee referral management, authorization requirements, reinsurance reporting, and inpatient review processes • Assist with policy and procedure creation and lead implementation of program changes • Monitor staff competency and production levels • Perform RN staff duties during coverage needs or work reassignment • Identify process improvement opportunities and evaluate approved program changes • Monitor OHP, DMAP, and Medicare rules and communicate changes to stakeholders • Attend state and other utilization and review meetings and report to the Manager and department • Ensure service requests and authorizations comply with OHP, Medicare, and coverage determinations • Develop unit and training materials • Complete utilization and review reports • Orient and train new employees and provide ongoing staff training • Recommend and implement technology improvements; maintain knowledge of QNXT and SharePoint • Draft technology assessments for Medical Director review • Act as a resource for department staff and Medical Directors • Support financial-impact initiatives and collaborate across CareOregon departments • Identify cases requiring Chief Medical Officer review • Assign reinsurance reviews based on high-dollar case identification • Supervise, coach, evaluate, and develop employees • Plan and monitor staffing, schedules, goals, performance, and corrective action in collaboration with Human Resources

🎯 Requirements

• Current unrestricted Oregon Registered Nurse’s license • Minimum 1 year utilization management or prior authorization RN experience • Preferred: minimum 1 year experience in a supervisory or lead position, or completion of CareOregon’s Aspiring Leaders Program • Preferred: 2 years’ utilization management or prior authorization RN experience • Preferred: experience with Oregon Health Plan (OHP), DMAP, and/or CMS rules and regulations • Knowledge of utilization management practice principles and industry-standard criteria • Knowledge of InterQual review criteria • Knowledge of OHP benefits, rules, and regulations • Knowledge of Medicare A and B benefits and Medicare Advantage regulations • Knowledge of managed care and utilization management principles • Knowledge of ICD-9, CPT, and HCPCS coding • Ability to develop and implement processes and procedures • Ability to provide leadership and supervision • Ability to use word-processing, spreadsheet, and database programs • Effective written and verbal communication skills • Ability to work effectively with diverse individuals and groups • Ability to perform required visual, auditory, communication, and repetitive hand/wrist movements for at least 6 hours per day

🏖️ Benefits

• Bonus opportunity: SIP target of 5% annually • Medical, dental, vision, life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • PTO • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions for non-benefits-eligible employees • Remote work from home