• Job Description

  Req#: 2023-1913

  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.

  Responsible for supporting PacificSource’s Health-Related Social Needs (HRSN) program. In partnership with other organizational leaders and member-facing teams, Develop and deploy PacificSource’s strategy to administer the HRSN program and ensure eligible members’ equitable access to HRSN benefits consistent with Oregon’s 1115 Medicaid waiver. The Program Manager will develop and oversee PacificSource’s work to invest in HRSN infrastructure, including grantmaking programs. Partner with Provider Network and Information Technology departments to build and maintain a network with community-based organizations (CBOs) and vendors, as well as a closed-loop referral system. Develop policies, procedures, and mechanisms to pay entities that provide HRSN benefits to members, including expanding PacificSource’s capability to pay CBOs and vendors through Community Information Exchange pathways. Partner with Health Services to design and administer HRSN benefits, programs, and targeted interventions. Support PacificSource in meeting Oregon Health Authority (OHA) obligations, including regulatory reporting, financial reconciliation, and program integrity functions.

  Essential Responsibilities:

  • Develop an HRSN program that will meet or exceed OHA requirements, promote positive member outcomes, improve community health, and serve members consistent with PacificSource’s values.
  • Support PacificSource in developing organizational competencies to deliver climate supports, housing supports, and food and nutrition supports.
  • Administer HRSN capacity-building infrastructure funds through grantmaking, contracting, procurement, or delegation activities.
  • Build and maintain a network of vendors and CBOs to deliver HRSN benefits to members.
  • Collaborate with organizational subject matter experts to develop strategies and payment methodologies, including closed-loop referral pathways, to pay entities that deliver HRSN benefits.
  • Develop CBO and vendor oversight and monitoring programs to ensure appropriate provider capacity and member service levels.
  • Support member-facing teams in building policies, procedures, and templates to screen for and identify eligible members, generate and accept referrals, screen members, create individual service plans, deliver HRSN benefits to eligible members, and follow up with members and CBOs.
  • In collaboration with Community Health Department staff and the Training and Facilitation Manager, develop and conduct training and technical assistance for PacificSource staff, health providers, CBOs, and others working to deliver HRSN benefits.
  • Meet regularly with community stakeholder and OHA representatives to discuss issues of concern and interest.
  • Collaborate with community stakeholders and partner with health council staff to meet or exceed OHA requirements.
  • Contribute to each PacificSource coordinated care organization (CCO) Community Health Assessment, Community Health Improvement Plan, and Health Equity Plan.
  • As directed by organizational leaders, support PacificSource’s overarching community health, health equity, social determinants of health, and tribal engagement strategy, including advancing efforts to maximize the impact of funding streams, align community priorities, and foster creative investments to improve the health of members and communities.
  • Collaborate with peers to influence development of Community Information Exchange capabilities to meet HRSN program needs.
  • Communicate with PacificSource leadership to bring forward issues of concern, improvement opportunities, and lessons learned.
  • In collaboration with others, develop and execute a communication strategy for the HRSN program for internal and external stakeholders.
  • Facilitate the resolution of issues that arise between CCOs, vendors, CBOs, providers, and others in delivering HRSN benefits.
  • Collaborate with the Medicaid Administration Department and others to fulfill CCO contractual and regulatory requirements, including, but not limited to, generating reports, reconciling payments, building budgets, and supporting rate development efforts.
  • Participate in internal and external committees, workgroups, and taskforces as requested.
  • Collaborate with regional leaders and key departments around potential business development activities and opportunities.
  • Participate as a key team member in company meetings and within the Community Health Department.

  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 PROFILE

  Work Experience: A minimum of 4 years’ experience required working in community health or social services. Experience in program development, administration, and contracting required. Demonstrated experience in housing, climate, nutrition, or other services and supports strongly preferred. Experience with Oregon’s Medicaid program and coordinated care organizations strongly preferred. Experience with Medicaid waiver funding and transitional services and support programs desired.

  Education, Certificates, Licenses: A bachelor’s degree is required, preferably in public health, social services, or a related field, or equivalent work experience.

  Knowledge: Current knowledge of Oregon safety net programs, community-based services and supports, and community resources. Current knowledge of community-based health care delivery trends, new technologies, funding streams, and statewide and national economic issues affecting member and community health. This position requires a strong and versatile communicator, able to work with diverse internal and external stakeholders.

  Competencies

  Adaptability

  Building Customer Loyalty

  Building Strategic Work Relationships

  Building Trust

  Continuous Improvement

  Contributing to Team Success

  Planning and Organizing

  Work Standards

  Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time, within Oregon.

  Skills:

  Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

  Our Values

  We 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.

• About the company

  We're anything but a typical health plan. Because we're an independent, not-for-profit organization we're able to focus on helping you get the care you need - not on delivering financial benefits to shareholders. We do that by building strong partnersh...

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