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CareOregon Health Care Coordinator (NARA IMCE) in Portland, Oregon

To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment.

Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregon’s standard accommodation process.

Position Title: Health Care Coordinator

Department: Population Health Partnership

Title of Manager: Care Team Supervisor

Supervises: Non-supervisory position

Exemption Status: Non-Exempt

Requisition: 18436

General Statement of Duties

The Health Care Coordinator provides non-clinical care coordination services to Oregon Health Plan (OHP) and CareOregon Advantage (COA) members who are identified as aged, blind, or disabled, have special or complex health care needs, are high utilizers of services, suffer from multiple chronic conditions or behavioral health issues or who receive Long-Term Care services under the State’s 1915(i) State Plan Amendment. The Health Care Coordinator acts an entry point to CareOregon’s care teams, provides intake functions, assesses member needs, coordinates with providers, and assists CareOregon’s clinical care coordination staff (RN or Behavioral Health professionals) with coordination activities. A focus of this position is to work in concert with members’ health care providers in assuring timely access to care, maintaining continuity of care and optimizing member well-being.

Population Focus

Health Care Coordinators working with the American Indian/Alaska Native program work exclusively with American Indian (AI) and Alaskan Native (AN) Fee-for-Service (FFS) OHP members according to established tribal and department protocols. All other Health Care Coordinators receive work assignments based on member population changes and department needs.

Essential Position Functions

  • Serve as the first point of contact within the Care Coordination Team for members or providers who call CareOregon requesting assistance.

  • Respond to requests for Care Coordination (sometimes referred to as Intensive Case Management Services) within one business day.

  • Call and interview members who: are deemed to have special healthcare needs, have had a recent Emergency Department (ED) visit, have been discharged from a facility (hospital, skilled nursing facility [SNF], inpatient rehabilitation), or are identified by an internal or external referral source.

  • Coach members in navigating the health care delivery system, gaining access to appropriate community resources, negotiating transitions in their health care, and determining ways to improve self-management and satisfaction with their quality of life.

  • Refer members with complex medical or behavioral health issues to CareOregon’s clinical care coordination staff.

  • Use motivational interviewing to coach members toward improved health care behaviors and self-management.

  • Assist in completing Health Risk Assessments with members, identifying coordination needs, and assisting with the care planning process.

  • Develop working partnerships with community health care providers regarding member needs and care plans.

  • Take independent actions to address members’ identified needs including, but not limited to: scheduling provider appointments, arranging for transportation, verifying needed services are provided, referring to community resources and locating members.

  • Develop basic care plans, contribute to and implement complex and integrated plans of care under the direction of clinical care coordination staff.

  • Participate in multidisciplinary rounds during which members’ needs are discussed and evaluated and plans of care developed or updated and present care plan information, as needed.

  • Coordinate care planning activities with health care providers, Aging and People with Disabilities caseworkers, Oregon Health Authority Innovator Agents and Client Services Unit staff, business partners, vendors, community agencies, and other relevant parties when requested by clinical care coordination staff.

  • Obtain chart notes or provider documentation, as needed.

  • Complete initial and subsequent documentation and processes in care coordination activities and when supporting clinicians in creation of plans of care, according to unit policy.

  • Maintain member case management files according to department protocols.

  • Maintain working knowledge of OHP and COA plan benefits as they relate to members enrolled in case management programs.

  • Creatively utilize available community resources as an adjunct to health plan benefits and follow-up to determine if these are received by the member.

  • Participate in team huddles, develop and implement PDSA cycles and evaluate team related process improvement outcomes.

  • Report member complaints to the appropriate authority for investigation and follow-up, per protocol.

    Intensive Care Coordination (ICC)/Exceptional Needs Care Coordination (ENCC)

    Requirements

  • Assist members to ensure timely access to providers and mandated/capitated services.

  • Communicate members’ unique needs to providers for consideration in planning treatment.

  • At the discretion of the RN or BH clinician, may assist providers with coordination of mandated/capitated services and discharge planning.

  • Coordinate community support and social service systems with healthcare systems, as deemed appropriate and necessary.

    Essential Department and Organizational Functions

  • Propose and implement process improvements.

  • Meet deadlines for completion of workload.

  • Maintain agreed upon work schedule.

  • Demonstrate cooperation and teamwork.

  • Provide cross-training on specific job responsibilities.

  • Meet identified business goals that contribute to departmental goals.

  • Report member complaints to the appropriate authority for investigation and follow-up, per protocol.

  • Maintain strict confidentiality, observing all HIPAA rules.

  • Maintain professional boundaries and effective working relationships with CareOregon staff, members, and providers.

  • Participate in work-related continuing education when offered or directed.

  • Follow departmental and organizational policies and procedures.

  • Perform other duties and projects as assigned.

    Knowledge, Skills and Abilities Required

  • 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 and ability to manage multiple tasks and timelines

  • 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

  • Knowledge of basic medical terminology, ICD and CPT codes and concepts of managed care

  • Intermediate computer application skills, including MS Windows, Word, Excel and Outlook

  • 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 (HCC/AI AN) for 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

    Physical Skills and Abilities

    Lifting/Carrying up to 0 Pounds

    Pushing/Pulling up to 0 Pounds

    Pinching/Retrieving Small Objects

    Crouching/Crawling

    Reaching

    Climbing Stairs

    Repetitive Finger/Wrist/Elbow/

    Shoulder/Neck Movement

    0 hours/day

    0 hours/day

    0 hours/day

    0 hours/day

    0 hours/day

    0 hours/day

    More than 6 hours/day

    Standing

    Walking

    Sitting

    Bending

    Seeing

    Reading

    Hearing

    Speaking Clearly

    0 hours/day

    0 hours/day

    0 hours/day

    0 hours/day

    More than 6 hours/day

    More than 6 hours/day

    3-6 hours/day

    3-6 hours/day

    Cognitive and Other Skills and Abilities

    Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

    Education and/or Experience

    Minimum two years’ experience required working in a healthcare setting, outpatient primary care clinic, hospital, or health insurance plan, preferably including experience interviewing patients and/or members for health information. Preference may be given to applicants with the following certifications: Licensed practical nurse (LPN), certified medical assistant (CMA), or certified nurse’s assistant (CNA). Preference may also be given to candidates with the following experience: 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. .

    Working Conditions

  • Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

    ☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

    ☐ Other_____________

  • Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used. Driving infractions will be monitored in accordance with organizational policy.

  • Equipment: General office equipment

  • Hazards: n/a

    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.

    Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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