HexaQuest Global

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan.. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.. Licensed Clinical Social Worker (LCSW).. Licensed Professional Counselor (LPC).. Licensed Marriage and Family Therapist (LMFT).

utilization review

Job Description JOB SUMMARY/PURPOSE Reviews, assesses, and evaluates clinical information used to support Utilization Management (UM) decisions based on established clinical criteria and applies intermediate knowledge of coding and medical record research. Facilitates professional communication to ensure the authorization process is completed in a patient centered manner with adherence to quality and timeline standards. Applies knowledge of applicable Medicare (CMS), Medicaid (OHA), and other plan specific rules and regulations to the authorization process. Reviews cases that have a low to moderate level of service intensity. Department Description Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together. Experience/Education/Qualifications Master's degree in Mental Health, Social Work, Clinical Psychology or a closely related field required. Current unencumbered Oregon credential/licensure in one (1) of the following required: Licensed Clinical Social Worker (LCSW). Licensed Professional Counselor (LPC). Licensed Psychologist (PhD or PsyD). Clinical Social Work Associate (CSWA). Licensed Master of Social Work (LMSW). Licensed Marriage and Family Therapist (LMFT). One (1) Year Clinical 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). Experience In The Following Preferred Utilization management. Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Position Urgency Normal Shifts Days, occasional weekends, ending 4/30 State License Details Not Needed Minimum Years Of Experience 1 Minimum Guaranteed Hours 40 Specialty Type Behavioral Health Sub Specialty Social Worker-Clinical Bilingual No EMR Used EPIC Vacation Coverage Required No

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