Yamhill Community Care · 3 weeks ago
Clinical Support Specialist - Care Management (CSS - CM)
McMinnville, OR
Full-time
Hybrid
Entry, Mid Level
2+ years expYamhill Community Care is a nonprofit coordinated care organization dedicated to managing healthcare for Medicaid members. The Clinical Support Specialist will perform case management support duties, engaging and coordinating activities for chronically ill Medicaid members, while collaborating with various stakeholders to improve member outcomes.
CommunitiesHealth CareNon Profit
Responsibilities
Administers member identification and engagement
Collaborates with YCCO staff and community partners to ensure positive outcomes for members and serves as a liaison between care managers, providers, and members to support comprehensive communication and education
Ensures documentation reflects clinical support activities performed and is aligned with regulatory requirements
Consults with colleagues and community partners to ensure all members requiring care coordination or case management services are readily identified by the CCO
Reviews and processes referrals, ensures appropriate monitoring, evaluates and reports on multi-agency referral and home visiting systems and makes appropriate referrals both internally and externally to appropriate departments / resources
Completes outreach calls to identified priority population members for specific case management programs
Provides direct member service including responding to incoming calls and routing to appropriate person/department
Directs and assists members in completing Health Risk Assessments to identify coordination needs and begin the care planning process
Advocates for members / families where member concerns are heard, access to providers is facilitated, and community resources are made available
Utilizes expertise to ensure identification and outreach to selected high-risk individuals by working with providers, partners, staff, and other care team members
Uses motivational interviewing to coach members towards improved healthcare behaviors
Performs work that includes the member, family members, providers, and care team participants to evaluate participant’s health conditions, make recommendations to participant on preventative and follow-up care; and educating participants on condition(s) and risk, including when condition(s) are worsening
Generates and creates community confidence in YCCO programs and services by embracing and exhibiting the Vision and Mission of YCCO
Provides excellent customer service, meets the needs of clients while interacting in a respectful and culturally appropriate manner
Takes independent actions to address members identified needs including, but not limited to: schedules provider appointments, arranges for transportation, verifies needed services are provided, refers to community resources and locates members
Represents the Plan, facilitates cross-setting communication including clinic providers, community partners, and member support teams
Proactively establishes trusting relationships through regular contact, participates on Multi-Disciplinary Team, consults with other professionals in the areas of oral and behavioral health, pharmacists, primary care, etc
Educates and ensures collaborative communication among providers from all networks (physical, behavioral, dental, transportation, traditional health workers)
Drives person-centered services by educating self and others of YCCO programs and services and other resources available for populations served
Educates members in navigating the health care delivery system, gains access to appropriate community resources, negotiates transitions in their health care, and determines ways to improve self-management
Generates correspondence with clinical staff, providers, and members of the care team to meet turnaround time requirements
Contributes to the creation of care plans and the implementation of complex and integrated plans of care under the direction of clinical care coordination staff
Identifies and collects all required documentation as set forth by Federal, State, funding regulations, and Agency policy
Serves as a Mandatory Reporter of suspected abuse of vulnerable populations as required by policy and regulation
Maintains a high level of accuracy when processing and sharing information according to privacy regulations
Protects clients and reduces YCCO risk by modeling and following policies, regulations, and requirements of Oregon Health Authority and YCCO
Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members
Participates in the preparation and submission of regulatory and contract required deliverables
Works closely with other YCCO departments, including Compliance to assist with audits; including the External Quality Review (EQR), as needed
Proposes and implements process improvements
Meets deadlines for completion of assigned responsibilities and projects
Maintains agreed upon work schedule with punctual, regular, and predictable attendance
Demonstrates cooperation and teamwork using a professional and respectful demeanor
Provides cross-training on specific job responsibilities
Meets identified goals that contribute to departmental goals
Works collaboratively in a team and matrixed (cross-department) environment with a spirit of cooperation
Respectfully takes direction from Supervisor
Performs other duties as assigned
Qualification
Required
Minimum two (2) years of experience in healthcare setting including experience with case management, disease management, and/or quality improvement departments
Any combination of education and experience that would qualify candidate for the position
Preferred
Bilingual (English/Spanish)
Associates or Bachelor's in Health related field
Knowledge of Oregon Medicaid requirements prior authorization and/or utilization review services
Company
Yamhill Community Care
Yamhill Community Care (YCCO) is a Coordinated Care Organization (CCO) that serves Oregon Health Plan (OHP) members in Yamhill County, and parts of Washington and Polk counties.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Seamus McCarthy
President and Chief Executive Officer
Company data provided by crunchbase