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CareOregon · 13 hours ago

High Risk Triage Coordinator I

United States

Full-time

Remote

Mid Level

$22.82/hr - $27.89/hr

3+ years exp

CareOregon is a healthcare organization focused on improving the quality of care for vulnerable populations. The High Risk Triage Coordinator I role involves providing clinical operations support, coordinating care, and identifying members' needs to enhance access to advanced illness care.

Health Care

Responsibilities

Gather and review all available and relevant information in order to help determine the physical, behavioral, social support, and medical needs of the member in order to help determine the individualized plan of care or support clinical staff working with the member

Identify members’ barriers to care and potential resources in consideration of cultural factors, social determinants of health, and member autonomy

Review and assess daily emergency department reports, hospital admission reports, and other targeted patient lists, health plan claims, pharmacy records, EHR, and other relevant information to identify members in need of additional support

Respond to internal and external inquiries, referrals, and service requests for assistance

Effectively respond to requests for Intensive Case Management Services for members who: are deemed high risk (complex clinical and/or behavioral or chemical dependency), 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

Contribute to and implement integrated plans of care as applies in collaboration with telephone, outreach, and embedded staff

Establish effective relationships with community partners and maintain active familiarity with key services and resources commonly requested by members

Develop working partnerships with health care providers regarding member needs and care coordination plans

Support coordinated care organizations (CCO) and Centers for Medicare and Medicaid Services (CMS) regulatory obligations

Collaborate with others within the organization to ensure the integration of assigned program activities with other organizational projects, as directed

Provide guidance and assistance to staff, as directed, with regards to needs for training, tools, technology, and other resources necessary to carry out their work

Provide population support, including work with a variety of vendors, or community partners

Conduct value stream mapping, process development and improvement, and program coordination

Coordinate multiple CareOregon initiatives to be inclusive of all lines of businesses

Identify opportunities for increased case finding efficiencies and effectiveness

Collect and/or audit data and information to inform or evaluate departmental, organizational metrics and regulatory requirements

Contribute to continuous process improvement through team huddles, training, departmental and organizational meetings, and reporting

Ensure correct data inputs through consistent reporting and frequent data audits

Run reports and track incoming referrals

Qualification

Vulnerable populationsMedical terminologyElectronic health recordsData analysis skillsProficient in Microsoft OfficeInterpersonal skillsEffective communication skillsOrganizational skillsWork independentlyDetail oriented

Required

Minimum 3 years' directly related experience working with vulnerable populations in a healthcare setting, social service agency, outpatient primary care clinic, hospital, or health insurance plan; experience should include working with consumers of Medicaid and Medicare healthcare services

Understanding of the impacts of trauma on health

Basic understanding of medical terminology

Familiarity with health plan claims systems and other sources of clinical information in an applied fashion to recognize potentially modifiable patterns of health services

Familiarity with electronic health record applications; comfortable learning new systems if needed

General understanding of or ability to learn the basics of motivational interviewing, health care teaching, and coaching principles

Proficient skills in Microsoft Office, including Word, Excel, and Outlook

Basic understanding of data analysis and use of analytical tools (Tableau Prep, Tableau Desktop, Excel, Power BI, etc.)

Skills in working with electronic medical records

Ability to identify medical or social situations in data that pose a risk to member's safety and increase likelihood of rehospitalization

Ability to effectively gather relevant information from members, or those calling on their behalf, regarding their health

Ability to develop a concise, initial assessment to appropriately triage

Willingness to seek support from clinical staff and/or supervisors in the event of complex situations

Proficient communication skills, including written, verbal, listening, and presenting

Strong interpersonal and customer service skills

Strong organizational skills; ability prioritize and manage multiple tasks and timelines

Ability to work independently and use sound judgment

Ability to work in a fast-paced, multi-faceted environment

Ability to apply critical analysis, creative problem-solving skills, and collaboration in multi-disciplinary teams

Detail oriented; accurate record keeping

Ability to work in an environment with diverse individuals and groups

Ability to work effectively 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, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Preferred

Licensed practical nurse (LPN), certified medical assistant (CMA), certified nurse's assistant (CNA), or other health related field

Experience working with Metrics, gaps in care, and/or HEDIS measures

Benefits

Medical

Dental

Vision

Life

AD&D

Disability insurance

Health savings account

Flexible spending account(s)

Lifestyle spending account

Employee assistance program

Wellness program

Discounts

Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)

Strong retirement plan with employer contributions

PTO

Paid State Sick Time

Paid holidays

Volunteer time

Jury duty

Bereavement leave