Qureos Mentor

CareOregon

<div>Benefit Management Operations Supervisor
-
This position is responsible for supervising daily benefit management operations and staff. Work includes implementing and monitoring processes and procedures that support Care Management program goals and organizational strategic objectives, as well as ensuring staff are performing at required competency and production levels. This position may perform the tasks of non-clinical Medical Management staff during times of coverage needs or reassignment of work.
Estimated Hiring Range:
$72,765.00 - $88,935.00
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
-<h2 class="jobSectionHeader">
Essential Responsibilities</h2><ul><li>
Identify opportunities to improve the program&rsquo;s effectiveness and efficiency of work processes.</li><li>
Implement, monitor and evaluate approved program changes.</li><li>
Keep abreast of Oregon Health Plan (OHP), Medical Assistance Program (MAP), and Medicare rules and regulations; inform manager, staff and other stakeholders of changes that impact decisions and practice.</li><li>
Ensure that services requests and authorizations are processed according to the (OHP) rules and regulations, Medicare regulations, and National and Local Coverage Determinations.</li><li>
Develop process documentation and training materials as needed.</li><li>
Provide orientation to new employees or provide oversight to staff who will provide the orientation.</li><li>
Provide on-going training to address programmatic and staff needs in all areas of utilization management functions.</li><li>
Make recommendations regarding the use of technologies that may enhance departmental performance and serve as a departmental resource for the implementation of any such technology.</li><li>
Keep current on system process and issues, including QNXT functions and SharePoint, including upgrades and upgrade testing.</li><li>
Act as a resource for staff and Medical Directors.</li><li>
Work with identified CareOregon staff and departments to find opportunities to support financial impact initiatives.</li><li>
Work collaboratively with other CareOregon departments.</li><li>
Ensure that CareOregon authorization decisions are based on coverage rules.</li></ul>
Team Assignment/Coverage<ul><li>
Remain informed about current processes and tasks performed by prior authorization, referral, appeal, claim review, and concurrent review staff.</li><li>
Stay current with work processes by providing periodic coverage for staff assignments.</li><li>
Work with staff to determine coverage in the event of unplanned absences.</li><li>
Cover an assignment when necessary.</li></ul>
Employee Supervision<ul><li>
Supervise team and recommend team direction and goals in alignment with the organizational mission, vision, and values.</li><li>
Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.</li><li>
Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.</li><li>
Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.</li><li>
Train, supervise, motivate, and coach employees; provide support toward employee development.</li><li>
Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.</li><li>
Ensure team adheres to department and organizational standards, policies, and procedures.</li><li>
Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).</li><li>
Perform supervisory tasks in collaboration with Human Resources as needed.</li></ul>
Experience and/or Education
Required<ul><li>
Minimum 2 years&rsquo; experience in practice management of primary or specialty care and/or Health Plan Operations that includes utilization review activity</li></ul>
Preferred<ul><li>
Minimum 1 year experience in a supervisory or lead position or completion of CareOregon&rsquo;s Aspiring Leaders Program; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks</li><li>
Utilization management experience</li></ul><h2 class="jobSectionHeader">
Knowledge, Skills and Abilities Required</h2>
Knowledge<ul><li>
Knowledge of utilization management practice principles and industry standard criteria</li><li>
Knowledge of Oregon Health Plan (OHP) benefit package including rules and regulations that pertain to health plan operations</li><li>
Knowledge of Oregon Medical Assistance Program (MAP)</li><li>
Knowledge of the Centers for Medicare and Medicaid Services (CMS) rules and regulations, including Medicare A and B benefits and regulations governing Medicare Advantage plans</li><li>
Knowledge of principles of managed care and utilization management</li><li>
Knowledge of ICD-9, CPT, HCPCS coding</li></ul>
Skills and Abilities<ul><li>
Ability to work with the department, stakeholders or customers to effectively resolve issues</li><li>
Ability to use critical thinking skills in problem solving</li><li>
Ability to manage multiple tasks and to remain flexible in a dynamic work environment</li><li>
Ability to function autonomously and to effectively set priorities</li><li>
Ability to present a positive and professional image</li><li>
Ability to develop and implement processes and procedures</li><li>
Ability to provide effective leadership and supervision to groups of people</li><li>
Ability to read, write and verbally communicate effectively</li><li>
Excellent customer service skills</li><li>
Ability to use basic word processing, spreadsheet and database programs and the ability to learn more complex programs</li><li>
Ability to work effectively with diverse individuals and groups</li><li>
Ability to learn, focus, understand, and evaluate information and determine appropriate actions</li><li>
Ability to accept direction and feedback, as well as tolerate and manage stress</li><li>
Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day</li></ul>
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee&rsquo;s personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&amp;D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.</div>

Benefit Management Operations Supervisor

<div>Accountant, Senior
-
This position performs senior level accounting functions for the organization. Primary responsibilities include general ledger maintenance, analysis and reporting. This position is also responsible for internal and external relations, auditing, and general administration. The Accountant, Senior position is responsible for coding accounts payable invoices and check requests, journal entry preparation, account reconciliation and ad hoc reports. 
 
This is a hybrid position, with an expectation to be in the office one day per week. We are seeking candidates based in the Portland Metro area.
Estimated Hiring Range:
$81,000.00 - $99,000.00
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
-<h2 class="jobSectionHeader">
Essential Responsibilities</h2>
This position&rsquo;s area of focus and expertise consists of one or more of the following topics:<ul><li>
Treasury functions including initiating wire transfers and other automated clearing house transactions.</li><li>
Behavioral health contract review, payment tracking and payment calculations.</li><li>
Alternative payment methodology accounting and review of payment calculations.</li><li>
Various claim service activity accounting and payment review.</li><li>
Allocation management and facilitation of quarterly meetings with Company leaders.</li><li>
Revenue accounting for Medicaid and Medicare payments.</li><li>
Invoice preparation for contracts, administrative services, and management services agreements.</li><li>
Intercompany account reconciliations and related eliminating journal entries.</li><li>
Fixed asset and prepaid expense subledger maintenance, including adding new assets, disposition of assets, monthly depreciation and amortization and compliance with Company capitalization policies.</li><li>
Company credit card program and expense reimbursement accounting, including coding of charges, review of transactions for policy compliance and employee point of contact for questions.</li><li>
Preparation of monthly internal reporting and accompanying financial letter.</li><li>
Insurance renewal preparation and management of Company-wide data gathering efforts .</li><li>
Payroll and payroll benefits accounting, review of bi-weekly payroll and manual payroll checks for payment approval, preparation of check requests for benefits paid outside of the payroll system, and preparation of bi-weekly 401(k) uploads.</li><li>
Payroll tax filings and accounting, ensuring the company&rsquo;s compliance with local, state and federal payroll and regulations, correspondence with payroll processor related to amendments to tax filings and discrepancies, filing of payroll tax and workers compensation, and state and local tax account setup as needed for new jurisdictions.</li></ul>
General Ledger Maintenance &amp; Analysis<ul><li>
Prepare routine to complex general ledger journal entries and calculate large estimates; assist in reviewing routine journal entries performed by others.</li><li>
Prepare monthly account reconciliations for complex accounts; maintain appropriate GL support.</li><li>
Review and analyze data to ensure accuracy and regulatory compliance; make or coordinate corrections as needed.</li><li>
Prepare advanced trend and data analysis.</li><li>
Interact with accounts payable staff on AP and cash receipts activities, including reviewing and coding invoices.</li></ul>
Reporting<ul><li>
Prepare monthly financial reporting packages.</li><li>
Prepare external financial reporting, including regulatory filings; respond to regulatory inquiries.</li><li>
Develop reports for ad-hoc requests using excel or GL software; run routine reports.</li><li>
Maintain and create financial reports in reporting software.</li><li>
Participate in presenting financial statements at Finance Committee and Board meetings with outside entities.</li><li>
Support year-end audit request and assist in audited financial statement preparation.</li></ul>
Internal &amp; External Relations<ul><li>
Develop and maintain effective working relationships with internal departments, teams, and leaders and external entities.</li><li>
Serve as an advanced resource for finance staff.</li></ul>
Administration<ul><li>
Support and train developing accounting staff.</li><li>
Participate in 1:1, team, and department meetings; attend All Staff meetings.</li><li>
Track and document allocation of time.</li><li>
Identify and help implement process improvements with minimal supervision.</li></ul>
Experience and/or Education
Required<ul><li>
Minimum 5 years&rsquo; experience as an Accountant (3-4 years&rsquo; Accountant experience may be considered with a Bachelor&rsquo;s Degree in Accounting and with core experience from public accounting or financial reporting)</li></ul>
Preferred<ul><li>
Accounting work experience in the health insurance industry</li><li>
Bachelor&rsquo;s Degree in Accounting, Finance, or related field</li><li>
CPA license</li></ul><h2 class="jobSectionHeader">
Knowledge, Skills and Abilities Required</h2>
Knowledge<ul><li>
Proficient understanding of GAAP and applicable laws and regulations, ability to recommend appropriate accounting and reporting treatment for transactions</li><li>
Proficient understanding of internal controls and department policies and procedures</li></ul>
Skills and Abilities<ul><li>
Mastery of one or more core organizational accounting functions (e.g., IBNR, Medicare estimates, Risk Corridors, Regulatory Reporting, Audit, Reporting software)</li><li>
Strong research and analytical skills</li><li>
Intermediate Microsoft Excel skills (e.g., advanced formulas, sumifs, vlookups, pivots, appropriate application of formulas and graphs, etc.)</li><li>
Strong attention to detail and accuracy; ability to produce high quality output, requiring some review</li><li>
Effective communication skills, including listening, verbal, and written</li><li>
High degree of initiative, motivation, and professionalism</li><li>
Developing ability to influence others</li><li>
Ability to interpret data</li><li>
Ability to articulate and present information within the department</li><li>
Ability to communicate with external parties (e.g., auditors, actuaries, regulatory agencies, etc.)</li><li>
Ability to effectively assist with projects and/or lead small projects</li><li>
Ability to support implementation of organizational or departmental change</li><li>
Ability to identify and help implement process improvements with some supervision</li><li>
Ability to identify problem, inconsistencies, unexpected results, relevant information and uncertainties</li><li>
Ability to interpret and organize information in a meaningful way and articulate assumptions;</li><li>
Ability to communicate findings and potential solutions to appropriate team members</li><li>
Time management skills; ability to prioritize work and complete tasks on time</li><li>
Ability to effectively collaborate with coworkers</li><li>
Ability to accept feedback and adapts to change</li><li>
Ability to maintain a positive attitude</li><li>
Ability to work effectively with diverse individuals and groups</li><li>
Ability to learn, focus, understand, and evaluate information and determine appropriate actions</li><li>
Ability to accept direction and feedback, as well as tolerate and manage stress</li><li>
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day</li><li>
Ability to hear and speak clearly for at least 3-6 hours/day</li></ul>
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee&rsquo;s personal vehicle, local transit or other means of transportation may be used.
Work Location: Hybrid-Office 1 day/week
Schedule: Ability to work during Finance Core Business Hours.
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&amp;D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.</div>

Accountant, Senior

<div>Investigations Unit Investigator, Senior
-
This position is responsible for administering the fraud, waste, and abuse (FWA) duties at an advanced level for CareOregon and its affiliated lines of business. Core work includes ensuring effective measures are in place and operating effectively to prevent, detect, and correct any instances of fraud, waste, and abuse. This includes performing advanced level of fraud investigations and providing regular FWA reporting to regulatory agencies. Additionally, this position helps ensure that appropriate procedures are in place and followed consistently to safeguard its assets, verify the accuracy and reliability of data, and promote efficient and effective operations.
Estimated Hiring Range:
$90,225.00 - $110,275.00
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
-<h2 class="jobSectionHeader">
Essential Responsibilities</h2><ul><li>
Contribute to the development and operation of an effective FWA program in accordance with CMS requirements and the Federal Sentencing Guidelines with guidance from department leadership.</li><li>
Perform routine and advanced FWA investigations, utilizing advanced investigative skills and diplomacy.</li><li>
Prepare reports of audit findings; provide recommendations regarding improvements or corrective actions where a deficiency may exist.</li><li>
Prepare routine and ad hoc reports for internal and external leaders, committees, and governing body, including collecting, analyzing, and displaying data.</li><li>
Prepare, proofread, and distribute correspondence, forms, and other information of a specialized and confidential nature.</li><li>
Develop and maintain an organized, methodical documentation system for communicating, implementing, and administering new and existing FWA regulatory requirements.</li><li>
Educate and coach leaders and staff regarding FWA requirements, including complex issues.</li><li>
Develop and/or utilize FWA dashboards and corresponding summaries used to identify and monitor current compliance and trending of all FWA matters including case details and metrics.</li><li>
Help identify potential areas of FWA vulnerability and risk; assist department leadership in developing and implementing corrective action plans for resolution of problematic issues and provide general guidance on how to avoid or deal with similar situations in the future.</li><li>
Participate in completing required Medicare and Medicaid filings and/or responses for FWA.</li></ul>
Experience and/or Education
Required<ul><li>
Minimum 5 years&rsquo; experience in compliance and/or audit, including minimum 1 year experience focused on fraud, waste, and abuse</li><li>
CPC (Certified Professional Coder) or RHIT (Registered Health Information Technician) or CFE (Certified Fraud Examiner</li></ul>
Preferred<ul><li>
Fraud, waste and abuse experience in Medicaid or Medicare</li></ul><h2 class="jobSectionHeader">
Knowledge, Skills and Abilities Required</h2>
Knowledge<ul><li>
Advanced understanding of healthcare fraud, waste and abuse</li><li>
Strong knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid Programs</li><li>
Advanced knowledge of investigative techniques, including interviews, data analytics, evidence gathering, case documentation</li><li>
Solid understanding of information and reporting systems</li></ul>
Skills and Abilities<ul><li>
Strong communication skills, including written, verbal and listening skills</li><li>
Advanced research, investigative and problem-solving skills</li><li>
Growing ability to build conceptual models and communicate complex ideas effectively</li><li>
Ability to facilitate learning opportunities in a variety of informal and formal settings</li><li>
Ability to make presentations to small and large groups</li><li>
Ability to think logically and creatively without undue influence from personal biases</li><li>
Ability to plan, organize, and monitor work projects</li><li>
Ability to work effectively with diverse individuals and groups</li><li>
Ability to learn, focus, understand, and evaluate information and determine appropriate actions</li><li>
Ability to accept direction and feedback, as well as tolerate and manage stress</li><li>
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day</li><li>
Ability to hear and speak clearly for at least 3-6 hours/day</li></ul>
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee&rsquo;s personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&amp;D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.</div>

Investigations Unit Investigator, Senior

<div>Special Investigations Unit Manager
-
This position manages and administers fraud, waste and abuse (FWA) for CareOregon and two wholly-owned Coordinated Care Organizations (CCOs) &ndash; Columbia Pacific CCO (CPCCO) and Jackson Care Connect CCO (JCC CCO). This includes leading, overseeing and/or performing fraud investigations and providing regular FWA reporting to all CareOregon CCOs. Additionally, this position manages internal staff and provides FWA oversight for Third-Party Administrative (TPA) activities CareOregon performs on behalf of the Health Share CCO.
Estimated Hiring Range:
$111,690.00 - $136,510.00
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
-<h2 class="jobSectionHeader">
Essential Responsibilities</h2>
Fraud, Waste and Abuse Management<ul><li>
Manage the development and operation of an effective fraud, waste, and abuse program in accordance with CMS requirements and the Federal Sentencing Guidelines with guidance from department leadership, including:<ul><li>
Recommendation and implementation of FWA policies and the FWA annual plan</li><li>
Periodic reporting to the organization&rsquo;s Internal Compliance Committee and governing Board of Directors</li><li>
Effective training and education</li><li>
Establishment and maintenance of effective lines of communication at all levels of the organization (to include a non-compliance reporting hotline)</li><li>
Development and oversight of effective system for routine FWA monitoring, auditing and identification of compliance risks</li><li>
Collaboration with other departments to ensure compliance issues are reported to appropriate channels for investigation and resolution</li><li>
Clear and specific policies, procedures and standards relating compliance monitoring activities.</li></ul></li></ul><ul><li>
Ensure the timely completion of the annual FWA work plan and evaluate the corresponding work performed by department staff.</li><li>
Perform and manage FWA investigations conducted by CareOregon staff, affiliates, and business partners.</li><li>
Complete and file all required Medicare and Medicaid filings and/or responses for FWA.</li><li>
Manage the development of sufficient and accurate monthly FWA dashboards and corresponding summaries used to identify and monitor current compliance and trending of all FWA matters including case details and metrics.</li><li>
Identify potential areas of FWA vulnerability and risk; partner with department leadership in developing and implementing corrective action plans for resolution of problematic issues and provide general guidance on how to avoid or deal with similar situations in the future.</li><li>
Provide input into strategic planning and budget planning for the department.</li></ul>
Employee Supervision<ul><li>
Manage team and recommend team direction and goals in alignment with the organizational mission, vision, and values.</li><li>
Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.</li><li>
Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.</li><li>
Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.</li><li>
Train, supervise, motivate, and coach employees; provide support toward employee development.</li><li>
Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.</li><li>
Ensure team adheres to department and organizational standards, policies, and procedures.</li><li>
Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).</li><li>
Perform supervisory tasks in collaboration with Human Resources as needed.</li></ul>
Experience and/or Education
Required<ul><li>
As required by our Medicaid contract, the individual must be a professional investigator, paralegal, professional coder, or auditor with corresponding certification</li><li>
Minimum 5 years&rsquo; experience in compliance and/or audit, including minimum 2 years focused on fraud, waste, and abuse</li></ul>
Preferred<ul><li>
Minimum 2 years&rsquo; experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon&rsquo;s Aspiring Leaders Program</li><li>
Fraud, waste and abuse experience in Medicaid or Medicare</li></ul><h2 class="jobSectionHeader">
Knowledge, Skills and Abilities Required</h2>
Knowledge<ul><li>
Advanced understanding of healthcare fraud, waste and abuse</li><li>
Strong knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid Programs</li><li>
Strong knowledge of investigative techniques, including interviews, data analytics, evidence gathering, case documentation</li><li>
Solid understanding of information and reporting systems</li><li>
Knowledge about how the functions of a business work and relate to one another to benefit the member by improving regulatory compliance</li></ul>
Skills and Abilities<ul><li>
Excellent written and verbal communication skills</li><li>
Strong research, investigative and problem-solving skills</li><li>
Strong interpersonal and motivational skills</li><li>
People leadership skills, including the ability to manage and coach team members</li><li>
Ability to facilitate learning opportunities in a variety of informal and formal settings</li><li>
Ability to make presentations to small and large groups</li><li>
Ability to think logically and creatively without undue influence from personal biases</li><li>
Ability to build conceptual models and communicate complex ideas effectively</li><li>
Ability to plan, organize, manage, and monitor work projects</li><li>
Ability to serve in an internal consulting role, assisting the organization&rsquo;s management and staff in embracing our goal of &ldquo;doing it right the first time&rdquo; and being cognizant of the company&rsquo;s commitments to its various partners and the need to achieve excellent results in our work product and processes</li><li>
Ability to work effectively with diverse individuals and groups</li><li>
Ability to learn, focus, understand, and evaluate information and determine appropriate actions</li><li>
Ability to accept direction and feedback, as well as tolerate and manage stress</li><li>
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day</li><li>
Ability to hear and speak clearly for at least 3-6 hours/day</li></ul>
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee&rsquo;s personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&amp;D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.</div>

Special Investigations Unit Manager

<div>Nurse Practitioner / NP - Primary Care - Hourly
-
This position provides medical care and treatment services with emphasis on chronic disease management and promotion of health and palliative care for patients not best served in a clinic setting. Care is provided in patient residencies, as well through audio and video sessions. This position may focus on one of the following areas: 
 
New Patient intake: Provides initial comprehensive assessment management and on-boarding of new patients to the clinic. 
Relief Care: Provides post hospital visits or urgent care visits for change in condition and supports change in the plan of care where needed. Provides relief and/or urgent care for patients on a short-term basis, focusing on filling in for providers who are out of the office. 
NOTE: This is a 16 hr/wk (0.4 FTE) position.
Estimated Hiring Range:
$66.42 - $81.18
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
-<h2 class="jobSectionHeader">
Essential Responsibilities</h2>
Clinical Service<ul><li>
Provide diagnosis, treatment, consultation, and follow-up care of patients in collaboration with patient assigned PCP including diagnosis and treatment of critical, prolonged, and long-term healthcare issues.</li><li>
Perform comprehensive health assessment of clients by completing a physical and psychosocial history; identify actual and potential health needs based on medical, mental/emotional, financial, and social factors.</li><li>
Make referrals to appropriate social or medical agencies and practitioners.</li><li>
Identify, evaluate, and address the prevention of diseases, maintenance of chronic diseases, and appropriate end-of-life care per the goals of care outlined by the patient and their families.</li><li>
Develop and implement proactive patient centered care plan with the assistance of other disciplines within the care team.</li><li>
Order testing in diagnostics, orders medications with appropriate follow up and reassessment, and performs some surgical procedures as appropriate under certification.</li><li>
Approve medication refills and home health orders and respond to caregiver requests to provide continuity of care.</li><li>
Provide compassionate anticipatory guidance through decline due to chronic disease and provide high quality palliative care focused on the goals of the patient and family.</li><li>
Educate patients and families on goal-based, appropriate preventative care, medical issues, and use of prescribed medications and treatment.</li><li>
Develop and maintain relationships with lay and professional caregivers, including care facilities, to assure patient experience excellent continuity of care and orders are implemented appropriately.</li><li>
Educate patients and families on their preventive care, medical issues, and use of prescribed medications and treatment.</li><li>
Deliver quality care while maintaining all company metrics pertaining to productivity.</li><li>
Practice within the scope of license where applicable, and as required by law and regulation.</li><li>
May participate in the after-hours call schedule.</li></ul>
Administration<ul><li>
Communicate effectively with members of the medical staff on issues concerning consultation, collaboration, and referrals.</li><li>
Educate patients and families on their preventive care, medical issues, and use of prescribed medications and treatment.</li><li>
Determine need for specialty and rehabilitative services and make appropriate referrals.</li><li>
Attend and participate in all required staff meetings and other ad hoc committees as assigned.</li><li>
Provide coverage for clinical colleagues in their absence.</li><li>
Participate in quality improvement activities as assigned.</li><li>
Complete and maintains medical records according to agency protocols and in support of quality metrics. Document new patient history and physical to appropriate coding standards and quality metrics.</li></ul><h2 class="jobSectionHeader">
Organizational Responsibilities</h2><ul><li>
Perform work in alignment with the organization&rsquo;s mission, vision and values.</li><li>
Support the organization&rsquo;s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.</li><li>
Strive to meet annual business goals in support of the organization&rsquo;s strategic goals.</li><li>
Adhere to the organization&rsquo;s policies, procedures and other relevant compliance needs.</li><li>
Perform other duties as needed.</li></ul>
Experience and/or Education
Required<ul><li>
Master&rsquo;s degree from an accredited advanced nurse practitioner program</li><li>
Licensed nurse practitioner in the state of Oregon (ANCC or AANP certified)</li><li>
Drug Enforcement Administration (DEA) license</li><li>
Valid driver&rsquo;s license, acceptable driving record, and automobile liability coverage or access to an insured vehicle</li><li>
CPR certification at hire or within 6 months in position</li></ul>
Preferred<ul><li>
Minimum 2 years of related clinical experience</li></ul><h3 class="jobSectionHeader">
Knowledge, Skills and Abilities Required</h3>
Knowledge<ul><li>
Knowledge of the principles and practice of medicine especially</li><li>
Knowledge of principles, practices and procedures of general medicine</li><li>
Knowledge of methods and techniques of diagnosing and treating a variety of diseases and injuries</li><li>
Knowledge of sources of information and current literature applicable to the field of general medicine</li><li>
Knowledge of the ethical and medico-legal aspects of medical practice</li><li>
Knowledge of the principles and practices of public health, including familiarity with epidemiology, health services delivery and financing systems, and environmental health</li><li>
Knowledge of the population served in adult health, including culture, demographics, patterns of disease, barriers to care and other unique features or special needs</li><li>
Knowledge of the principles and practices of clinical quality improvement</li></ul>
Skills and Abilities<ul><li>
Proficient in the practice of geriatrics and palliative care</li><li>
Skill in utilizing electronic systems appropriately and effectively, including audio and video supported encounters</li><li>
Ability to perform medical diagnostic and treatment services</li><li>
Ability to establish and maintain effective working relationships with diverse patients, staff, peer groups, and varied agency and institutional representatives</li><li>
Ability to deal professionally and calmly with individuals that may act inappropriately, be verbally abusive, hostile and/or in crisis</li><li>
Ability to communicate clearly, compassionately, and concisely, both verbally and in writing</li><li>
Cultural competence and ability to work effectively with people from all walks of life</li><li>
Compassion, commitment, and integrity required for success in this position</li><li>
Ability to work within a team and take direction from other team members with expertise in the care plan development</li><li>
Ability to adhere to organizational standards, policies, procedures.</li><li>
Ability to work effectively with diverse individuals and groups</li></ul><ul><li>
Ability to learn, focus, understand, and evaluate information and determine appropriate actions</li><li>
Ability to accept direction and feedback, as well as tolerate and manage stress and grief</li><li>
Ability to see, read, hear, speak clearly, sit and perform repetitive finger and wrist movement for at least 6 hours/day</li></ul><ul><li>
Ability to stand, climb stairs, bend, lift, carry, push, pull and/or pinch small objects for at least 3-6 hours/day</li><li>
Ability to walk, crouch, crawl and reach for at least 3 hours/day</li><li>
Ability to operate a motorized vehicle in all kinds of weather conditions</li></ul>
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical, ergonomic, and biological hazards
Equipment: General office equipment and/or mobile technology
Travel: This position requires travel outside of the workplace at least weekly; the employee&rsquo;s personal vehicle may be used. Driving infractions will be monitored in accordance with organizational policy.
Work Location: Hybrid-Community 2 days/week, member facing
Location: Employees permanently assigned to see members and patients in Marion or Polk counties are required to live within 15 miles of their county assignment.
Schedule: Work a flexible schedule, including evenings and weekends.
If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws.
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. Housecall Providers offers medical, dental, vision, life, AD&amp;D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
Housecall Providers is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.</div>

Nurse Practitioner / NP - Primary Care - Hourly