Health Care CoordinatorThe Health Care Coordinator (HCC) serves as a key entry point to CareOregon’s Regional Care Teams and provides comprehensive care coordination. Responsibilities include intake, navigation of physical and behavioral health benefits, and development of individualized care plans based on member needs. The HCC collaborates closely with members, providers, and external partners (e.g., Oregon Health Authority, Tri-County 911, hospitals, county case workers, internal departments, etc.) to ensure timely access to services, continuity of care, and improved member outcomes.
Estimated Hiring Range:
$25.42 - $31.07
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
Essential Responsibilities
Intake, Triage, and Referral Management
- 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, especially those tied to social determinants of health.
- Coordinate referrals from members, providers, community partners, and internal CareOregon departments and teams.
- Provide call escalation support for Customer Service Representatives when necessary.
- Determine navigation, care coordination and/or resource needs in response to referrals and other types of calls into the Regional Care Team (RCT) phone lines.
- Identify members in crisis, triage needs requiring urgent attention, and help de-escalate high-need callers.
- Triage appropriate referrals and help determine care coordinator assignment for RCT clinical care coordinators based on identified member needs.
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.
- Facilitate access and remove barriers to necessary care and services for members and families.
- Facilitate communication among members, their support systems, clinical care providers, community partners, and internal CareOregon departments, ensuring care plans are shared as appropriate.
- Coordinate effectively with interdisciplinary teams for integrated care plan support of complex member needs, participating in relevant team meetings. (Coordination frequently includes external parties such as community providers, state and county case workers, community partners, vendors, and agencies. Depending on assigned focus area, may also collaborate with Tribal health leaders.)
- Provide appropriate support to clinical Care Coordination staff involved with members.
- Assist members in establishing and engaging with providers.
- Refer members to appropriate agencies for community support.
- Coordinate care for members residing outside of service area as required in contract.
- Coordinate care for members discharging from the state hospital.
- Assist in transition and discharge planning for members moving from acute care, long-term care, or other residential facilities back to community-based supports as directed by clinical supervisor.
- Take independent actions to address each member’s identified needs including (but not limited to): scheduling provider appointments, arranging for transportation, arranging for an interpreter, confirming authorizations/referrals, assisting with Health-Related Services Flex requests, verifying needed services are provided, referring to community resources and locating members.
Member Assessment and Care Planning
- Assess for and identify physical and behavioral health care coordination needs.
- Identify and appropriately address risk factors and service needs that may impact member outcomes.
- Utilize a trauma-informed approach to provide member-centric physical and behavioral health care and support.
- Assist members in moving through the continuum of care based on clinical, medical, and 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 integrated physical and behavioral health care plans are timely, effective, and consider the members’ unique needs.
- Implement physical and behavioral health care coordination plans in collaboration with the member, providers, case workers and other relevant parties.
- Develop working partnerships with community health care providers concerning member needs and care plans.
Compliance and Administration
- Maintain compliance with Coordinated Care Organization (CCO) requirements
- Complete initial and subsequent documentation for care coordination activities and support clinical care coordinators in plan creation adhering to required timelines.
- Maintain working knowledge of CareOregon Advantage (COA) and Oregon Health Plan (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 whose practice patterns do not conform 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.
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), certified nurse’s assistant (CNA), or Traditional Health Care Worker (THW) certification
- Experience working directly or telephonically with populations utilizing OHP
- Experience working with populations impacted by mental health and/or addictions
- Experience working with insurance plans and/or interviewing patients or members about their health information
- Experience working in Epic
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 (e.g., language, cultural factors, transportation, self-management capacity, psychosocial issues) and ability to bring these issues 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 benefit package and Oregon Health Plan rules and regulations
- Knowledge of Medicare parts A and B benefit packages and the Centers for Medicare and Medicaid Services (CMS) rules and regulations
- Familiarity with support methods for individuals with Substance Use Disorder (SUD)
Skills and Abilities
- Ability to read, write and verbally communicate effectively
- Excellent listening, interpersonal and customer service skills
- Ability to communicate positively and professionally via the telephone
- Intermediate computer application skills, including MS Windows, Word, Excel and Outlook
- Motivational interviewing, health care teaching, and coaching skills or ability to learn
- Ability to manage multiple tasks and timelines in a high-stress environment
- Ability to work independently and also collaboratively with colleagues, providers, community agencies and OHA staff
- Ability to work in an environment with diverse individuals and groups
- 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
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. (Member Facing)
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.
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&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.
Originally posted on Himalayas