Job Information

CareOregon Inc. Clinical Operations Manager in Seattle, Washington

Career Opportunities: Clinical Operations Manager (24516) Requisition ID 24516 - Posted 08/09/2024 - Health Share of Oregon - Full Time - Permanent - Portland - Multi Location (2) Job Description Print Preview Job Title Clinical Operations Manager Exemption Status Exempt Management Level Manager Direct Reports Health System Navigators Manager Title Director, Integrated Services Department 610, Integration Pay and Benefits Estimated hiring range $121,797 - $148,863 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a hybrid role that will require you to occasionally go into the downtown Portland office for meetings. Job Summary This position is responsible for directing and managing clinical and non-clinical staff and resources. Areas of oversight include direction, coordination and monitoring of Health Share delegated care coordination programs. This includes the responsibility for the development and implementation of program standards and procedures, monitoring program impact, and ensuring effectiveness and integrity. This position works closely with and provides guidance to other managers and directors across the organization and Health Share health plan, health system, and county partners to ensure collaboration, integration and support of organizational activities and goals. This position is also responsible for developing state required reporting to the Oregon Health Authority regarding care coordination. Essential Responsibilities Operational Management Direct and oversee the coordination of Care Coordination activities across Health Share system partners, including the development of new reporting, communication, and monitoring activities. Work collaboratively with Health Plan and County leaders to ensure implementation of new State of Oregon rules, as well as procedures to monitor program impact and effectiveness. Develop and implement monitoring programs and services to ensure compliance to the CCO Contract and Oregon Administrative Rules for Care Coordination activities. Ensure Care Coordination policies and procedures meet Division of Medical Assistance Program (DMAP) requirements and the Centers for Medicare and Medicaid (CMS) requirements. Ensure Care Coordination and Navigation program compliance with DMAP, CMS, and other relevant regulatory bodies that oversee health plan operations. Direct and ensure integration of work between Health Share's system partners; manage changes across Health Share departments, and communications within Health Share, and between partners, and providers. Ensure new OHA risk stratification requirements are implemented at Health Share and at the Health Share plan partners Direct and work with Health Share system partners and health information technology staff in the development of centralized member risk stratification processes Act as a technical and operational resource to Health Share staff and Health Plan and County Care Coordination leadership. Ensure unit work is performed in coordination with other relevant CCO functions; serve as a liaison and collaborator with multiple teams including CCO customer service, claims, appeals and grievances, population health, information systems, and others. Keep current on standards for health plan operations related to Care Coordination and case management. Perform on-going analysis of data and information, looking for opportunities for improvement in appropriate utilization of resources. Frequently communicate with Health System partners to problem solve issues and improv