PacificSource

Manager, Inpatient and Post Acute Services

Portland, OR

Sponsorship not specified$92k-$160kDetected 9 days ago

ComplianceProcess ImprovementHIPAALeadershipCommunicationCollaborationPublic Speaking

About the role

Collaborate with hospital case managers, providers, and interdisciplinary teams to facilitate safe and cost-effective discharge plans for patients.
Develop, implement, and regularly update policies and procedures to ensure compliance and best practices in utilization management.
Prepare for and manage internal and external audits pertaining to UM and DSNP activities to ensure compliance and readiness.
Work closely with the UM Director to facilitate the development and implementation of new programs and support ongoing success of department goals and initiatives.
Recruit, train, and mentor clinical reviewers, nurses, coordinators, and other UM personnel to build a skilled and knowledgeable team.
Conduct performance evaluations, set goals, and foster professional development to maintain a high-performing team.
Develop and track metrics to evaluate utilization trends, authorization outcomes, readmission rates, and other key performance indicators, presenting monthly/quarterly dashboards and reports to senior leadership with actionable insights for continuous improvement.
Perform other duties as assigned.
This role ensures compliance with regulatory requirements, optimizes quality and cost-effectiveness, and facilitates coordinated care across the care continuum.
Ability to develop, review and evaluate utilization and case management reports.

Ability to read and comprehend both written and spoken English.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
Travel is required approximately 10% of the time.
Prior supervisory or management experience required.
Knowledge of managed care products and third-party liability (TPL) is required.

Registered Nurse or Licensed Clinical Social Worker with current appropriate state licenses.
Certified Case Manager Certification as accredited by CCMC preferred.

Compensation Disclaimer
Base Range:
$91,587.15 - $160,277.52
The wage range provided reflects the full range for this position.
Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.

The wage range provided reflects the full range for this position.
The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage.
Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.
Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.
Develop and monitor the annual department budget: Develop the annual department budget, monitor spending versus the approved budget throughout the year, and take corrective action where needed.

Minimum of seven (7) years of clinical experience required and a minimum of 3 years direct health plan experience in case management, utilization management, or disease management.
Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes, including ICD-9 & 10, CPT codes, health insurance and State of Oregon mandated benefits.
Knowledge of health insurance and State mandated benefits experience in adult education preferred.

This listing is sourced directly from PacificSource's careers page and normalized into a canonical job model.