Post Date: 12/05/2018
Close Date: 12/18/2018
The Health Plan Policy, Performance, Research Analyst will focus on the Division’s health plan functions as a risk accepting entity of Health Share of Oregon. Tasks will include monitoring internal functions of the Division, supporting Oregon Health Plan members with investigating and resolving grievances, monitoring subcontracted mental health and addictions providers, in collaboration with Multnomah and Washington Counties and Health Share of Oregon, and processes both member and provider appeals in a timely manner. The position will also assist in the planning, development and coordination of a provider relations function to improve and promote a responsive, high performing delivery system of contracted provider organizations.
This position will participate on the Division’s Quality Assurance Committee and support efforts to ensure compliance with all state, federal, and local rules and regulations, and participate in the development and monitoring of the internal health plan and policies and procedures needed to effectively manage the benefits. Will assist in the preparation for Division audits, training for staff, development of corrective action plans, and provision of technical assistance to managers and supervisors to implement corrective action plans. Provide specific and comprehensive research and analysis for the Division's assessment of the fraud, waste and abuse program and risk evaluation on internal procedures as part of the annual Compliance Plan evaluation. Will collaborate with team to complete the annual Quality Assurance and Performance Improvement (QAPI) review and Quality Strategy demonstrating the effectiveness of the program.
Clackamas County is committed to building a workforce that reflects the community we serve. In that spirit, we encourage applicants of diverse backgrounds and experience to apply.
Required Minimum Qualifications/ Transferrable Skills:
• Must be a Qualified Mental Health Professional (QMHP)** as established by Oregon Administrative Rules.
• At least six (6) months of experience monitoring compliance with federal Medicaid rules, Oregon Administrative Rules (OARs), and Oregon Revised Statutes (ORS) as they apply to health care providers and practitioners.
• At least six (6) months of experience with quality management activities, such as developing and monitoring performance measures and quality indicators, completing chart audits, reviewing personnel records for compliance, and/or developing required trainings.
• Ability to manage difficult, sensitive and confidential situations with integrity and professionalism.
• Experience and ability to communicate effectively with people of diverse backgrounds, skill sets, and personalities.
• Must successfully pass a criminal history check which may include national or state fingerprint records check.
• Driving may be necessary for County business. For position(s) with occasional/incidental driving,
incumbents must possess a valid driver's license. Accommodation requests for an acceptable alternative method of transportation will be reviewed on an individual basis in compliance with State and Federal legislation.
Preferred Special Qualifications/ Transferrable Skills:
• Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC) to review appeal requests by members and providers.
• At least one (1) year experience tracking and managing a customer grievance and complaint system in a health care setting.
• Experience working with Electronic Healthcare Records.
• Intermediate proficiency in Microsoft Software Applications, such as MS Word and MS Excel.
• Experience in developing and maintaining documentation and/or policies and procedures.
SALARY & BENEFITS
Clackamas County offers competitive wages and an attractive benefits package, including a robust Wellness program.
• The salary range is $65,504 - $82,935 Annually
• This position works 40 hours during a standard workweek of Monday through Thursday (Friday’s off) OR Monday through Friday. Specific hours will be discussed at time of selection.
• Health Plan Options: Most employees are eligible to start most benefits after two months of continuous employment.
THE FLEXIBLE BENEFITS PROGRAM OFFERS:
• A Choice of Dental Plans and Medical Plans with Vision & Prescription Drug Coverage
• A Choice of Full Benefits or Lesser Benefits with Flex Cash
• Wellness and Employee Assistance Programs
• Paid Leave: (Vacation, Holidays, Sick Leave, Bereavement Leave)
• Group Term Life Insurance
• Long-Term Disability Insurance with Optional Salary Buy-Up Program
• Health Care Flexible Spending Account (FSA), Dependent Care Flexible Spending Account (FSA), Health Reimbursement Accounts (HRA)
• Optional Group Universal Life Insurance; Accidental Death & Dismemberment (AD&D) Insurance; Long Term Care Insurance; Voluntary Benefits through AFLAC, Liberty Mutual and Hyatt Legal
• Retirement: PERS/OPSRP Retirement Contributions Clackamas County contributes to member’s pension share account as well as picks up the 6% contribution to the Individual Account Program (IAP).
• Optional Deferred Compensation (457)
• Longevity Pay
HOW TO APPLY
Clackamas County accepts online applications only. To complete an online application and for more information, please visit http://www.clackamas.us/ and click on the “Jobs” tab
• Please follow the instructions to submit the on-line application. Instructions will include how to copy and paste a current resume. Please make sure to answer all the questions, including the open-ended questions!
• This position closes on December 18, 2018.
EQUAL EMPLOYMENT OPPORTUNITY / DRUG-FREE WORKPLACE
Department of Human Resources
Public Service Building 2051 Kaen Road, 3rd Floor Oregon City, OR 97045
Phone: (503) 655-8459 Hearing Impaired: (503) 657-4544 FAX: (503) 742-5468
Complete details: http://www.clackamas.us/des/jobs.html