Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

The Health Care Coordinator (HCC) acts an entry point to CareOregon's Regional Care Teams, as well as provides care coordination. This position provides intake functions, physical and behavioral health plan navigation, and care coordination including assessing member needs, developing individualized care plans, coordinating with providers and with members. A focus of this position is to work in concert with members' physical and behavioral health care providers, outside community partners/agencies and other external and internal partners (e.g., Oregon Health Authority/Ombudsperson, Tri County 911, county case workers, hospital social workers, physical health plan if not CO, dental health plan, NEMT dept, UM dept, Social Determinants Dept, Customer Service, etc.) in assuring timely access to care, maintaining continuity of care and optimizing member well-being. This position requires critical thinking and independent judgment as well comfort working with the organization's most vulnerable members.

This specific HCC position will be on our Maternal, Child, Youth Regional Care Team which providers care coordination to complex pediatric members, including youth involved in the child welfare system, as well as complex pregnancy and post-partum members. Having experience in these areas would be valuable although not required.

Essential Responsibilities

Intake, Triage, and Navigation

• Serve as the first point of contact within the Care Coordination Team for members or providers who call CareOregon requesting assistance with physical and behavioral health needs, as well as social determinants of health.
• Receive care coordination referrals from members, providers, community partners, and internal CareOregon departments and teams.
• Take call transfers from Member and Provider Customer Service when the need is beyond their knowledge and ability.
• Determine navigation, care coordination and/or resource needs in response to referrals and other calls into the RCT phone lines
• Determine if member is in crisis and needs urgent attention; help de-escalate high need callers.
• Based on identified needs, help determine care coordinator assignment and triage appropriate referrals to RCT clinical care coordinators.
• Assist members in establishing/engaging with providers.

Care Coordination

• Provide telephonic-based physical and behavioral health care coordination to eligible members and families.
• Maintain a caseload of members with ongoing physical and behavioral health care coordination needs.
• Assist members and families to access the care and services they need without barriers.
• Facilitate communication between members, their support systems, other community-based partners, clinical care providers and other CareOregon departments, and ensure care plans are shared, as appropriate.
• Effectively coordinate with an interdisciplinary team for integrated care plan support of complex members and participate in a variety of multidisciplinary care team meetings; coordination includes internal care team and frequently includes external members such as community providers, state and county case workers, community partners, vendors, agencies, contractors, other CareOregon departments and other relevant parties. (Health Care Coordinator /American Indian Alaska Native will also collaborate with Tribal health leaders.)
• Provide support as appropriate to clinical Care Coordination staff involved with the member.
• Assist members in establishing/engaging with providers.
• Refer members in care coordination to different agencies for community supports.
• Coordinate care for members residing outside of service area as required in contract.
• Coordinate care for members discharging from the state hospital.
• Coordinate care for members involved with county ICC programs or members that are transitioning out of ICC back to CareOregon Care Coordination.
• Assist in transition/discharge planning for members discharging from acute care settings or those who are transitioning from long term care, or other residential facilities to ensure a smooth transition back to community-based supports as deemed appropriate by clinical supervisor.
• Take independent actions to address members' identified needs including, but not limited to: scheduling provider appointments, arranging for transportation, arranging for an interpreter when needed, confirming authorization/referral is in place, assisting with Health Related Services Flex requests, verifying needed services are provided, referring to community resources and locating members.
• Develop working partnerships with community health care providers regarding member needs and care plans.

Assessment and Care Planning

• Assess for and identify physical and behavioral health care coordination needs.
• Identify risk factors and service needs that may impact member outcomes and address appropriately.
• Utilize a trauma-informed approach to provide member-centric physical and behavioral health care and support.
• Assist in helping members move through the continuum of care based on clinical/medical/behavioral health needs.
• Use motivational interviewing to coach members toward improved physical and behavioral health care behaviors and self-management.
• Utilize assessment information to develop individualized care plans for assigned members.
• Coordinate with providers to ensure consideration is given to unique needs in integrated planning and that physical and behavioral health care plans are timely and effective.
• Implement physical and behavioral health care coordination plan in collaboration with member, providers, case workers and other relevant parties.

Compliance and Administration

• Maintain compliance with Coordinated Care Organization requirements
• Complete initial and subsequent documentation and processes in care coordination activities and when supporting clinical care coordinators in creation of plans of care, according to the care coordination timeline of activities.
• Maintain working knowledge of COA and OHP benefits, including Addictions and Mental health benefits.
• Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol.
• Assist Quality Assurance (QA) staff in identifying behavioral health providers with practice patterns which are not in conformity to best practice standards.
• Maintain compliance with the Model of Care requirements if applicable.
• Participate in quality and organizational process improvement activities and teams when requested.
• Participate in work-related continuing education when offered or directed.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 3 years' experience working in a healthcare setting, outpatient primary care clinic, hospital, or health insurance plan

Preferred

• Licensed practical nurse (LPN), certified medical assistant (CMA), or certified nurse's assistant (CNA)
• Working directly or telephonically with a population similar to that found on the Oregon Health Plan and/or working with a community-based mental health or addictions population
• Experience interviewing patients and/or members for health information

Knowledge, Skills and Abilities Required

Knowledge

• Knowledge of basic healthcare language, including medical and/or behavioral health
• Knowledge of community resources
• Knowledge of barriers to care such as language, cultural factors, transportation, ability to self-manage and psychosocial issues and bring those to the attention of the care team.
• Knowledge of culturally specific issues, resources and strengths of the AI AN populations for HCC positions focused on these populations
• Knowledge of Oregon Health Plan (OHP) benefit package and OHA rules and regulations
• Knowledge of Medicare parts A and B benefit packages and the Centers for Medicare and Medicaid Services (CMS) rules and regulations

Skills and Abilities

• Ability to read, write and verbally communicate effectively

• Excellent listening, interpersonal and customer service skills
• Motivational interviewing, health care teaching, and coaching skills or ability to learn
• Excellent organizational skills, plus ability to manage multiple tasks and timelines in a high stress environment
• Ability to work independently, when needed, and to use sound judgment
• Ability to establish and maintain effective, collaborative relationships with colleagues, providers, community agencies and OHA staff
• Ability to work in an environment with diverse individuals and groups
• Intermediate computer application skills, including MS Windows, Word, Excel and Outlook
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

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

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#LI-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.