Deployment Manager Salary in Boise, ID

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!! We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)Job Summary Develops and maintains provider relationships within designated state/territory, inclusive of relationships with both TriWest Network Subcontractors and any directly contracted provider groups. Manages network development activity with network subcontractors/network providers to ensure network meets all access standards. Provider network includes hospital, physician and ancillary service agreements. Provider Network Manager ensures adherence with government operational manuals, monitors network access, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives. Ensures that Network Subcontractors fulfill all performance obligations defined in their Health Network Agreement.Education & Experience Required: • Bachelor's degree in Business, Health Care Administration or equivalent experience • 2+ years of experience managing large or complex provider networks • 5 years of experience in a Managed Care or equivalent health care environment • 2+ years of experience managing provider contracts including pricing, discounts, and all associated terms and conditions Preferred: • Experience in provider contracting for government programs and/or commercial lines of business • Has established relationships and resides in the market for the which the position is located • Management experience in the healthcare industry • Experience in utilizing a contract management system to manage contracting workflow • Negotiation experience • Understanding Claims issues and termsKey Responsibilities• Maintains relationships with Network Subcontractors in state/market of operations. • Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics. • Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to department leadership for inclusion in overall network development plans. • Coordinates with Federal stakeholders to deploy network solutions to adhere to requirements of the contracts held by TriWest. • Collaborates with Federal stakeholders to identify areas of provider training and education to be incorporated into the TriWest provider education plan. • Aligns with Network Subcontractors and Federal Stakeholders to identify areas of opportunity for deployment of alternative payment models to support TriWest's network and improve health care outcomes. • Collaborates with internal leadership team to address network access.• Supports providers as needed, with issues related to claims, referrals, or any other program related activity. • Demonstrates and maintains current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals. • Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement. • Collaborates closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes. • Monitors and responds to network shortfalls within region through coordination with network subcontractors where appropriate. • Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities. • Provides regular updates to department leadership regarding provider network development, management, and access for assigned areas. • Communicates information regarding market needs, competition, and industry trends to management team. • Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues. • Regularly meets with network subcontractors/network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues. • Performs other duties as assigned. • Regular and reliable attendance is required.Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Leadership: Successfully manage Network Subcontractor relationships and associated contracts; takes accountability and follows through on service related requests. Responds with an appropriate sense of urgency. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VA Community Care Network), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.Working Conditions Working Conditions: • Availability to work non-regular hours as necessary • Works in a hybrid environment, with travel as needed • Must be able to obtain security clearance as required by government contractsCompany Overview Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage Generous paid time off 401(k) Retirement Savings Plan (with matching) Short-term and long-term disability, basic life, and accidental death and dismemberment insurance Tuition reimbursement Paid volunteer time *Annual base salary for Colorado and Washington State residents: $79,000 - $87,000 depending on experience*Equal Employment OpportunityTriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

NxEdge is a world class company providing vertically integrated solutions to the Semiconductor market. Our expertise in Engineering Material Coatings (EMC) allows global leading chip manufacturers and OEM equipment makers to achieve next generation technologies. We are seeking a driven, hands-on experienced Director of Quality to join our team that specializes in engineered materials and coating solutions for semiconductor applications worldwide.General Description:If you are a quality professional looking for an opportunity to grow, NxEdge has an exciting opportunity for you! You will provide leadership, direction, and accountability to create and support a world class quality culture across NxEdge by driving continuous improvement in products and business processes, internally and with our suppliers. You will develop and assure the implementation of corporate level strategies, programs, and procedures to provide continuous improvement of global quality performance, and integration of quality principles and activities within the overall business.AS THE DIRECTOR OF QUALITY YOU WILL: Manage the quality organization across NxEdge Direct and develop the quality resources in all NxEdge facilities Engage with key stakeholders to define strategy and future requirements for the Quality Management System Become a focal on the deployment of the Enpro Global Quality Community of Practice at NxEdge Establish and maintain quality management systems at each facility owned by NxEdge Identify near state addressable opportunities, and focus on risk identification and mitigation Focus on implementing and maintaining consistent quality metrics and improvement goals Gather, analyze, and distribute key information on systems performance. Define company wide harmonized elements/tools/work processes/terminology/KPI's our Quality Management System Measure, report, and drive breakthrough performance in all critical quality metrics Develop, implement, and maintain training that improves product and business process quality and reliability Manage by influence, build capabilities, train, and continuously develop the QA team at all sites. Evaluate the effectiveness of established programs, policies, and procedures Promote an open and collaborative cross-functional culture Develop and rollout a robust supplier quality management program Assist in new product development to establish quality standards, customer defined quality, supplier base and manufacturing capabilities are established prior to initial production Safeguard and be accountable for "Copy Exact" in all facilities Ensure that a strong and effective QMS audit program exists across all sites and is well maintained Continually improve and implement required changes to the Quality Management System. Develop and own a QMS maturity model and audit and report to leadership on the performance of site and regional management system implementation and opportunities for improvement WHO YOU ARE: You are self-directed and able to manage by influence You think strategically and act tactical You have a bias for action You tackle difficult issues with optimism and confidence. You pursue everything with energy, drive, and the need to finish. You focus efforts on continuous improvement; and have a knack for identifying and seizing opportunities for synergies and integration. You anticipate customer needs and provide services that are beyond customer expectations. You are a servant leader and react to the voice of the customer People Leadership Ability to manage people and projects Drive the vision, daily operation, and support of a high performing Corporate Quality function. PREFERRED EDUCATION, EXPERIENCE & SKILLS: 4 years degree and 4+ years of experience or 8+ years of experience in managing a quality program across multiple sites is required. Demonstrated leadership skills in guiding quality program Minimum of 2 years of experience in both quality and continuous improvement/lean/six sigma functions. Certified Quality Manager preferred Semiconductor experience preferred Strong technical background and knowledge of QA testing methods, procedures, and standards, as well as knowledge of ISO 9001 standards is a must Ability to work effectively with employees at all levels of the organization Legal authorization to work in the United States Strong written/verbal communication skills. Strong PC skills to include MS Office OTHER RESPONSIBILITIES: Performs other duties as assigned WORKING CONDITIONS: Travel Required. REPORTS TO: VP of Engineering and Quality EEO Statements: NxEdge, an Enpro company, is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law.

Machine Learning Scientist (Future Opportunities)Remote Within OR, WA, UT or ID**Please note this role is a candidate pool, and we are always looking for top talent. We do not always have open positions but we encourage you to submit your resume so you will be considered for all open roles as they become available.**Primary Job PurposeMachine Learning Scientists (MLS) work with various stakeholders to design, develop, and implement data-driven solutions. This position applies expertise in advanced analytical tools such as machine learning, deep learning, optimization, and statistical modeling to solve business problems in the healthcare payer domain. Data Scientists in the Machine Learning track work may focus on a particular area of the business such as clinical care delivery, customer experience, or payment integrity, or they may work across several areas spanning the organization. In addition to expertise in analysis, machine learning and deep learning, this role requires knowledge of data systems, basic software development best practices, and algorithmic design.Machine Learning Scientists work closely with AI team members in the Product and Engineering tracks to collaboratively develop and deliver models and data-driven products. ML Scientists also collaborate and communicate with business partners to design and develop data-driven solutions to business problems and interpret and communicate results to technical and non-technical audiences.General Functions and OutcomesFor MLS I:Note that these responsibilities are representative but not exhaustive. Higher level roles involve successively stronger degrees of initiative taking and innovation beyond the core responsibilities listed here.Researches, designs, develops, and implements data-driven models and algorithms using machine learning, deep learning, statistical, and other mathematical modeling techniques.Trains and tests models, and develops algorithms to solve business problems.Adheres to standard best-practices and establishes principled experimental frameworks for developing data-driven models.Develops models and performs experiments and analyses that are replicable by others.Uses open-source packages when appropriate to facilitate model developmentIdentifies, measures, analyzes, and visualizes drivers to explain model performance (e.g., feature importance, interpretability, bias and error analysis), both offline (in the development phase) and online (in production).Uses appropriate metrics and quantified outcomes to drive model and algorithm improvements.Analyzes, diagnoses, and resolves bugs in production machine learning models and systems.Evaluates model/use case feasibility by quickly generating prototypes.Takes models from prototype stage and improves performance as needed.Writes clean, well-commented, tested, version-controlled, and maintainable python code.Collaborates with team members and Cambia business partners.Actively participates in group meetings and discussions.Communicates effectively both orally and in writing with both technical and non-technical audiences.Keeps current with the state of the art in machine learning and AI and its application to healthcare.Keeps current with evolving commercial and open source tools, techniques, and brings these practices to projects.Over time develops familiarity and insight with various subdomains of healthcare dataAdditional General Functions & Outcomes for Machine Learning Scientist IIGenerates new features, by following examples, using SQL or SQL-like code.Works effectively with data that may be noisy, high dimensional, sparse and/or imbalanced.Contributes to the full life-cycle of modeling, from training, to model evaluation, to model deployment.Builds robust production grade machine learning pipelines using tools and patterns in the AI platform.Accesses and processes structured and unstructured data in various databases and formats.Assesses new machine learning capabilities and adapts them to our problems and environment.Identifies or develops appropriate model metrics and objective functions to ensure models satisfy stated business requirements and KPIs.Proactively identifies potential pitfalls and risks and develops ways to avoid them.Plays a role in ensuring that the work being carried out by the AI team has sufficient business value.Writes clean, well-commented, efficient Python code.Additional General Functions & Outcomes for Machine Learning Scientist Sr. IGenerates feature pipelines and datasets using novel data sources, where example SQL may not exist.Works with large datasets that require cloud resources or distributed computing.Takes on net new/greenfield work and establishes project foundations.Identifies and determines what data is available and relevant, including both internal and external data sources.Tech lead for 1-2 project teams, products, or end-to-end systems.Builds reusable machine learning components, pipelines and tools for others to use.Oversees technical output in their area(s)/domain(s).Researches and evaluates possible solutions, including but not limited to vendors, open-source pre-trained models, cloud services, etc.Stays abreast of novel approaches and techniques in the field. Shares new ideas and discoveries with the team and applies new ideas when appropriate to generate business value.Devises project plans to address business problems, drawing from an increasingly broad ML toolset grounded in hands-on experiences and prior successes delivering business value.In collaboration with Data Science Product Manager(s), develops target success criteria.Participates in recruitment efforts by the team.Mentors others to help develop their skills.Additional General Functions & Outcomes for Machine Learning Scientist Sr. IIContributes to the development of technical strategy and roadmaps in at least one major area of the AI portfolio.Leads technical aspects of large-scale initiatives.Makes material improvements in processes or infrastructure that reduces the load on team members.Develops materials (oral and written) within the Cambia community to increase awareness of AI/ML and how it can be applied in the healthcare payer space.Connects new machine learning opportunities and existing efforts to corporate and departmental strategies.Represents Cambia through publishing research and acquiring patents.Designs online experiments and assessment methods, for example A/A and A/B testing.Identifies industry trends in machine learning/healthcare and communicates the impact and opportunities to the team and business leaders.Works and interacts across the organization with a variety of business units.Identifies team learning objectives and builds curricula.Contributes to development of recruitment strategies for the AI team.Minimum RequirementsCompetencies and Knowledge:For all levels:Demonstrated knowledge of data science, machine learning, and modeling.Ability to use well-understood techniques and existing patterns to build, analyze, deploy, and maintain models.Effective in time and task management.Able to develop productive working relationships with colleagues and business partners.Strong interest in the healthcare industry. Core Knowledge:Machine Learning: Strong mathematical foundation and theoretical grasp of the concepts underlying machine learning, optimization, etc. (see below). Demonstrated understanding of how to structure simple machine learning pipelines (e.g., has prepared datasets, trained and tested models end-to-end).Data: Strong foundation in data analysis.Programming: Strong python programming skills. Familiarity with standard data science packages. Familiarity with standard software development best practices. Strong SQL skills a plus.Algorithms: Understanding of standard algorithms and data structures (ex. search & sort) and their analysis.Additional Minimum Requirements for Machine Learning Scientist IIAbility to code effectively in and create novel features and datasets using SQL or SQL-like languages.Ability to write clean, well-commented, efficient Python code.Strong understanding of techniques for working with noisy, high-dimensional, sparse, and/or imbalanced data.Demonstrates in-depth familiarity with at least one domain of data (e.g., claims data).Demonstrates depth of understanding in at least one major ML modeling technique or approach.Ability to develop new machine learning pipelines for both offline testing and online serving of models.Demonstrated track record of delivery of data science and machine learning models to solve well-defined business problems.Has working knowledge of department processes, procedures, and infrastructure.Able to identify common pitfalls in developing ML models (e.g., data leakage across features or partitions)Ability to translate business requirements into data science and machine learning discovery plans and modeling objectives.Ability to articulate the high-level business objectives of their work.Performs a range of data science tasks with a moderate level of guidance and direction.Ability to partner within and across departments to remove blocks and achieve results.Additional Minimum Requirements for Machine Learning Scientist Sr. IAdvanced SQL or SQL-like and Python coding skills.Ability to use novel techniques to solve challenging business problems.Demonstrates in-depth familiarity with at least two domains of data.Demonstrated ability to work with large datasets in a distributed computing environment.Demonstrates independent judgment in selecting methods and techniques for delivering results.Demonstrates expert-level technical skills in ML models and algorithms, and ensures technical quality of models and algorithms developed by others.Able to partner with business stakeholders on ill-defined or improperly defined goals, extract underlying needs, and develop a discovery plan.Able to quickly research and evaluate possible solutions to complex business problems.Able to lead projects or sub-projects within a broader product.Able to influence strategy and prioritization within their area(s).Able to assist and mentor less-experienced data scientists.Able to develop project plans.Normally receives little instruction on day-to-day work, general instructions on new assignments.Additional Minimum Requirements for Machine Learning Scientist Sr. IIAble to identify common patterns, and develop common tools and patterns to facilitate rapid experimentation, modeling, and development.Broad and comprehensive, but also technically-deep awareness of data science & machine learning advancements in the field.Demonstrated ability to influence strategy and prioritization.Ability to design online experiments and assessment methods.Experience advocating for AI/ML and developing a data-driven culture at an organization.Ability to develop training/workshop materials.Ability to communicate effectively across a large organization.Demonstrated track record of contributions to the field, e.g., through publications, blog posts, or patents.Normally to be proficient in the competencies listed above:Machine Learning Scientist I would have a degree (masters or PhD preferred) in a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and 0-3 years of related work experience, or equivalent combination of education and experience.Machine Learning Scientist II would have a degree (masters or PhD preferred) in a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically requires 4 years of related work experience. Equivalent combination of education and experience will be considered.Machine Learning Scientist Sr I would have a degree (masters or PhD preferred) in a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically requires at least 7 years of related work experience. Equivalent combination of education and experience will be considered.Machine Learning Scientist Sr II would have a degree (masters or PhD preferred) in a strongly a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically at least 12 years of related work experience. Equivalent combination of education and experience will be considered.Work EnvironmentWork primarily performed in an office environment and working from home may be considered. Travel may be required, locally or out of state. May be required to work overtime and outside of normal hours.The expected hiring range for a MLS I is $109,700 - $148,400, for a MLS II is $119,900 - $162,200, for a Sr MLS I is $145,400 - $196,700 and for a Sr MLS II is $176,000 - $238,100 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for a MLS I and MLS II is 15% & the bonus target for a Sr MLS I and Sr MLS II is 20%. The current full salary range for this role is $103,000 - $168,000 for MLS I, is $112,000 - $184,000 for MLS II, is $126,000 - $223,00 for Sr MLS I, and is $165,000 - $270,000 for Sr MLS II.Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

Job Description Summary Designs, develops, analyzes, troubleshoots, and documents computer network and infrastructure. Supports client environments as member of Logicalis' 24x7x365 operations team. Responsible for support, incident, problem, change, configuration, performance, and capacity management of devices and resources monitored by Logicalis Managed Services. Provides Tier 3 engineering and support for relevant technology of environments. Essential Duties and Responsibilities Designs, installs, and troubleshoots Cisco Application Centric Infrastructure fabric, including Network Centric and Application Centric deployments Performs design and analysis of IP addressing, network security, internet access, e-mail, DNS, NT related services, disaster recovery, content filtering, power considerations, and remote access. Demonstrates understanding of ethernet frames, frame switching, ether types, T-1, DS-3, PPP, Frame Relay. Masters assigned discipline within technical offering (ie: video, security network management, remote access, routing). Responds and solves client issues utilizing technology tools, procedures, and training through awareness of service offerings and Service Level Agreements (SLAs). Understands Information Technology Infrastructure Library (ITIL) and follows predefined ITIL incident, problem and change management processes in place for each client when working to resolve client requests or outages. Provides direct client interaction as needed in support of client operations. Performs a high level of troubleshooting. Develops design schematics (using Visio, MS PowerPoint and sketches.) Attains quick problem resolution during implementation and/or troubleshooting of systems. Tests, evaluates, and develops new products, offerings, and solutions.Conducts training of team members in both formal and informal environments. Handles several tasks simultaneously (ie: pre-sales designs, troubleshoot and develop internal network, respond to network down emergencies). Communicates all events that are not anticipated (new product requirements, equipment failure, design changes, schedule changes) with manager. Creates, uses and maintains technical and process documentation. Remains current on technical and company related literature/correspondence and regularly reviews administrative procedures. Coordinates service outages with Service Delivery Managers as required. Documents post-incident response and root cause analysis. Sets course for repeatable processes and auditing Logicalis processes against service descriptions. Provides technical leadership and acts as technical resource and mentor to team members. Oversees and executes as needed client health checks in support of client operations. Executes technology onboarding checklist (integration projects) and documents risks in integration projects. Demonstrates and actively promotes an understanding and commitment to the mission of Logicalis through performing behaviors consistent with the organization's values. Maintains a working knowledge of applicable Federal, State, and Local laws and regulations as well as policies and procedures of Logicalis in order to ensure adherence in a manner that reflects honest, ethical and professional behaviors. Supports and conducts self in a manner consistent with customer service expectations.Supervisory Responsibilities This job has no supervisory responsibilities. Qualifications To perform this job successfully, an individual should be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience/Technical Requirements/Certifications Equivalent combination accepted. Education: Bachelor's Degree in a related field. Experience / Technical Requirements 5 years in Cisco environments; switches, routers, and firewalls.Experience with Cisco SD-WAN (Viptela)Experience with Cisco DNA CenterExperience with Cisco MerakiExperience with Fortinet and/or Aruba network devicesSpecialty such as network infrastructure, network security or network management.Proficient use of all Microsoft Office applications. Certifications One or more of following Cisco certifications: Cisco Certified Network Associate (CCNA)Cisco Certified Network Professional (CCNP)Other Skills and Abilities Possess strong organizational skills, ability to prioritize work.Ability to multi-task (projects, new requirements, equipment failures, design changes).Exceptional customer service, verbal and written communication skills.Demonstrated track record for completing complex engineering tasks.Physical Demands The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is constantly required to sit, talk, see, hear, and use hands and arms. The employee is frequently required to stand; move about, climb steps or balance and stoop, kneel, crouch, or crawl. The employee may occasionally lift and/or move up to 10 pounds.The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified. Logicalis is an Equal Opportunity Employer. It is our policy to employ people who are qualified by reason of education, training, experience, and demonstrated performance. We value diversity and inclusion at our company. We do not discriminate on the basis of race, color, religion, national origin, sexual orientation, gender identity and gender expression, marital status, age, height, weight, disability, veteran status, or any other reason prohibited by applicablefederal or state laws. Salary Compensation Range: $77,500 to $101,000

Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.Manage the daily operations, including oversight/supervision of the Care Management Team which may include the following: Health Services Representatives (HSR) Member Support Specialists (MSS) and Nurse Case Managers (NCM) and Behavioral Health Clinicians involved in care coordination and case management functions. Key participant in Health Services (HS) strategy, program development and implementation. Integrally involved in, and accountable for, the success of the PacificSource Care Management program development and performance internal measures as well as those established by regulatory entities.Essential Responsibilities:Work closely with the HS Director and other HS Managers to facilitate the development and implementation of new programs and processes to support ongoing success of department goals and initiatives, including but not limited to; ongoing activities related to physical and behavioral health integration and the development of a cohesive team approach to care management.Foster effective teamwork and performance. Manage change and encourage innovation. Build collaborative relationships, encourage involvement and initiative and develop goal orientation in others.Take a leadership role in initiation and implementation of departmental process/performance improvement activities Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize LEAN methodologies for continuous improvement. Utilize visual boards and frequent huddles to monitor key performance indicators and identify improvement opportunities.Serve as back-up for the Director of Care Management and Utilization Management Manager, as needed.Work collaboratively with the UM Director and Manager Team to develop, implement, and oversee the utilization management process to include; coordination of prior authorization needs for members engaged with care management, as well as the inpatient concurrent review process to ensure medical appropriateness, care coordination needs, and discharge planning for PacificSource patients who have been hospitalized.Develop and oversee the care management process to ensure care coordination and case management needs of PacificSource's are being met and their outcomes are being improved.Ensures consistent workflow and a comprehensive database of patients enrolled in care management and care coordination programs that allows for tracking of case loads, case management program success or failure, and patient and population outcomes.Ensure nurse case managers are providing timely notification of large cases to finance, underwriting, stop loss and other company leaders, as necessary.Serve as key driver and participant to ensure PacificSource care management programs are coordinated with the case management and care coordination functions of our provider and community partners.Responsible for oversight, management, development, implementation, and communication of HS case management and care coordination programs that coordinate and augment community partner programs.Oversee and monitor processes to ensure the protection of personal health information.Facilitate the provision of exceptional customer service to members, providers, employers, agents, and other external and internal customers. Ensure that the delivery of services meet acceptable standards and company and customer expectations.Monitor, evaluate, and report performance relating to volumes, quality, outcomes, accuracy, customer service, and other performance objectives.Serve as a liaison with all PacificSource departments to coordinate optimal provision of service and information.Serve as a resource and participate in development of policies, procedures, and operations.Collaborate and coordinate Health Services department staff between regional offices. At regional offices, represent Health Services by serving on management teams and support marketing and development initiatives towards achievement of PacificSource Health Plans goals specific to the region.Attend continuing education opportunities relevant to case management and care coordination to ensure that PacificSource care management programs maintain current best practices and implement innovative models of care.Maintain frequent and consistent department meetings and one-on-one meetings with individual contributors.Establish and monitor progress towards goals for care management programs, including case loads, outcomes, case timeliness, quality of interventions, training and physician outreach efforts.Encourage and support team members in their pursuit of case management and care coordination certifications.Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback to direct reports, including regular one-on-ones and performance evaluations.Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.Coordinate business activities by maintaining collaborative partnerships with key departments.Actively participate as a key team member in Manager/Supervisor meetings and HS Management meetings.Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.Ensures ongoing monitoring and adherence to applicable state and federal regulatory and associated compliance requirements.Supporting Responsibilities:Meet department and company performance and attendance expectations.Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.Perform other duties as assigned.SUCCESS PROFILEWork Experience: 5 years clinical experience required. A minimum of 3 years direct health plan experience in case management, utilization management, or disease management, or equivalent preferred. Prior supervisory or management experience required.Education, Certificates, Licenses: Registered Nurse or Licensed Clinical Social Worker or other licensed healthcare or behavioral health care clinician, Oregon licensure required. Certified Case Manager Certification (CCM) as accredited by CCMC (The Commission for Case Management) strongly desired at time of hire. CCM certification required within two years of hire.Knowledge: Thorough knowledge and understanding of medical and behavioral health procedures, diagnoses, and treatment modalities, procedure codes, including ICD-9 & 10, DSM-IV & V, CPT codes, health insurance and State of Oregon mandated benefits. Knowledge of community services, providers, vendors and facilities available to assist members. Strong knowledge of health insurance; including managed care products as well as state mandated benefits. Ability to develop, review and evaluate utilization and care management reports. Experience in adult education preferred. Proficient in the use and implementation of the following tools and concepts across all teams within scope and accountability: Training, Coaching, Strategy Deployment, Daily Operations, Visual Management, Operational Improvement & Team Building/Development.Competencies:Building TrustBuilding a Successful TeamAligning Performance for SuccessBuilding PartnershipsCustomer FocusContinuous ImprovementDecision MakingFacilitating ChangeLeveraging DiversityDriving for ResultsEnvironment: Work inside in a general office setting with ergonomically configured equipment, as needed. Travel is required approximately 20% of the time.Skills:Accountable leadership, Collaboration, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic ThinkingOur ValuesWe live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. 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. Employment remains AT-WILL at all times.