Qureos Mentor

CareOregon

<div>Customer Service HRS Specialist
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The Customer Service HRS Specialist serves as the initial point of contact for members, providers and other external groups for a wide range of inquiries related to Health-Related Services (HRS). (HRS are certain flexible services defined as Health-Related Services by the state of Oregon.) The role is responsible for providing advanced customer service to support improved health care delivery and overall community health outcomes. This is an external facing role, and the majority of job duties involve inbound and outbound call work as well as other modes of communication.
Estimated Hiring Range:
$28.23 - $34.50
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>
Respond to inquiries originating from a wide range of customer groups including members, providers and other departments and organizations (e.g., community-based organizations, regulatory bodies such as the Oregon Health Authority, etc.).</li><li>
Communicate with customer groups via telephone, email and text as appropriate.</li><li>
Research, verify and resolve a broad array of inquiries, both simple and complex, related to Health-Related Services.</li><li>
Assist members with applying for Health-Related Services and obtaining information about the status of their requests.</li><li>
Provide clear communications, timely responses and high-level customer service.</li><li>
Use online tracking systems to document all activities and communications related to each Health-Related Services inquiry, request, status and outcome.</li><li>
Receive and apply updates on current, evolving policy and process changes related to Health-Related Services.</li><li>
Perform ongoing analyses of data and information to identify opportunities for improvement in operational efficiencies.</li><li>
Collaborate with teams inside and outside of the department to share information, obtain information and resolve customer inquiries.</li><li>
Partner closely with the Authorization team to gather and compile complete and accurate information for requests and coordinate any necessary outreach.</li><li>
Complete (off phone) administrative tasks and project work in an efficient and timely manner.</li><li>
Adhere to all Health Insurance Portability and Accountability Act (HIPAA) requirements and organizational standards related to protected health information, privacy and confidentiality.</li><li>
Create and update job aids, reference information and other documentation as needed.</li><li>
Participate in cross-departmental workgroups as needed.</li></ul>
Experience and/or Education
Required<ul><li>
Minimum 3 years&rsquo; customer service experience including 2 years supporting healthcare members, providers or health-related insurance providers, vendors or related entities</li><li>
Minimum 1 year experience in Call Center</li></ul>
Preferred<ul><li>
Customer service experience with a health insurance carrier/health plan, the Oregon Health Plan and/or roles providing crisis management</li></ul><h2 class="jobSectionHeader">
Knowledge, Skills and Abilities Required</h2>
Knowledge<ul><li>
Knowledge of or ability to quickly learn Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to medical health, Medicaid and Medicare Industry</li><li>
Knowledge of the basic concepts of Managed Care</li><li>
Knowledge of principles of organizational change and ability to act as a change agent</li><li>
Knowledge of Health-Related Services (HRS) requirements and processes</li></ul>
Skills and Abilities<ul><li>
Ability to learn and apply Oregon Administrative Rules (OARs), Federal Laws and various agency regulations as they relate to processing Health Related Services</li><li>
Ability to effectively use phone system and system reports</li><li>
Strong computer and data analysis skills</li><li>
Excellent interpersonal skills, customer service and strong active listening skills</li><li>
Excellent reading, spoken and written communication skills</li><li>
Ability to proactively work to build and improve team operations</li><li>
Ability to work under pressure in a complex and rapidly changing environment</li><li>
Basic mathematical skills</li><li>
Excellent problem solving and decision-making skills</li><li>
Ability to successfully manage multiple tasks</li><li>
Ability to support and comply with organizational policies, procedures, and guidelines</li><li>
Ability to participate fully and constructively in department meetings and contribute to decisions</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
Schedule: Operation hours are 7 days per week, 8:00AM &ndash; 8:00PM
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>

Customer Service HRS Specialist

<div>Nurse Practitioner / NP - Primary Care - Hourly
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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

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Customer Service HRS Specialist

Nurse Practitioner / NP - Primary Care - Hourly