Total Quality Manager jobs in Albany, OR

**Job Summary/Purpose:**
We are seeking a Care Manager to serve as a single point of contact for members and providers, guiding them through managed care. In this role, you will leverage your knowledge of regulations, identify available resources, and remove obstacles to ensure seamless care transitions. Your interventions will play a vital role in providing comprehensive support.

**Department Description:**
Samaritan Health Plans (SHP) manages a range of health plan products, including regional Coordinated Care Organization (CCO) services for Medicaid beneficiaries, Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans. We also administer self-funded employee health benefit plans aligned with Samaritan Health Services' mission.

**Experience/Education/Qualifications:**
- Unencumbered Oregon RN License required.
- Associate's degree in a health care related field required. BSN preferred.
- Minimum of three (3) years nursing experience required.
- Experience and/or training in health care delivery systems and/or managed care patients.
- Familiarity with computer applications, including electronic documentation.
- Preference for experience with Medicare and Medicaid rules, health plan benefit structures, and policies.

**Knowledge/Skills/Abilities:**
- Effective written and verbal communication skills for interactions with members, providers, and organization staff.
- Tactful approach to discussing issues, with the ability to comprehend complex information and situations.
- Proficiency in motivational interview techniques for working with members.
- Conflict resolution in a positive and constructive manner.
- Knowledge of State and Federal (HIPAA) laws related to confidentiality of protected health information.
- Critical thinking to identify complex problems, involve stakeholders, gather data, and make informed decisions.
- Social perceptiveness for diverse interactions with all age groups.
- Understanding of evidence-based clinical practice and criteria application for authorization requests.

**Additional Information:**
- Position Urgency: Normal
- Hours: Full-time (40 hours per week)
- Compensation: Competitive salary, benefits package
- Work Arrangement: Hybrid, including work from home, face-to-face visits, and occasional onsite meetings