HRSN Specialist RN I

• Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth 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.

This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

Candidates residing out of state will need to be able to work Pacific Time Zone hours.

Occasionally

• JOB SUMMARY/PURPOSE
• Reviews, assesses, and evaluates clinical information used to support the HRSN (health-related social needs) benefit decisions based on established clinical criteria and applies intermediate knowledge of coding and medical record research. Facilitates professional communication to ensure the HRSN process is completed in a patient centered manner with adherence to quality and timeline standards. Applies knowledge of applicable Medicaid (OHA) rules and regulations to the authorization process.
• EXPERIENCE/EDUCATION/QUALIFICATIONS
• Current unencumbered Oregon RN License required. BSN preferred.
• One (1) year clinical nursing 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.
• KNOWLEDGE/SKILLS/ABILITIES
• Knowledge of social determinants of health (SDoH) and the relationship to the member’s overall wellbeing.
• Knowledge of HRSN benefit, managed care principles, OHA requirements and OHP benefits and ability to incorporate this information into the HRSN coordination process.
• Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services and evaluation of customer service satisfaction.
• Ability to work, function and communicate on a multi-disciplinary team. Possess the knowledge and skills to develop constructive and cooperative working relationships with others and maintain them over time. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
• Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions respond quickly and appropriately.
• Ability to organize, plan and prioritize work to complete within required time frames and to follow-up on pending issues.
• Knowledge of medical terminology, ICD, CPT, and HCPCS codes.
• Strong communication skills (telephone skills with members, CBOs, interdepartmental communication).
• PHYSICAL DEMANDS
• Rarely (1 - 10% of the time)
  

(11 - 33% of the time)

Frequently

(34 - 66% of the time)

Continually

(67 – 100% of the time)

CLIMB - STAIRS

KNEEL (on knees)

SQUAT Static (hold >30 sec)

• LIFT (Floor to Waist: 0"-36") 40 - 60 Lbs
  
  

SIT

ROTATE TRUNK Sitting

REACH - Upward

CARRY 2-handed, 20 - 40 pounds

LIFT (Floor to Waist: 0"-36") 20 - 40 Lbs

STAND

WALK – LEVEL SURFACE

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

LIFT (Overhead: 54" and above) 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

CARRY 2-handed, 0 - 20 pounds

BEND FORWARD at waist

ROTATE TRUNK Standing

REACH - Forward

PUSH (0 - 20 pounds force)

PULL (0 - 20 pounds force)

MANUAL DEXTERITY Hands/wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand/Fist

PI265804789