Health Care Coordinator

Health Care Coordinator

The Health Care Coordinator (HCC) serves as a key entry point to CareOregon's Regional Care Teams and provides comprehensive care coordination. Responsibilities include answering phone lines, responding to voicemails, conducting intakes, 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.

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 Regional Care Team (RCT) phone lines requesting assistance with physical and behavioral health needs, especially those tied to social determinants of health. Answer phone lines and check voicemails left on RCT line daily and address any needs identified.
• 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 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 10-20 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 Dental, Vision, Hearing, Addictions, and Mental Health benefits.
• Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol.
• 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 clinical, social, or behavioral health setting, or health insurance plan

Preferred

• Certified medical assistant (CMA), certified nurse's assistant (CNA), Certified Alcohol and Drug Counselor (CADC), Medical Assistant (MA), or Traditional Health Care Worker (THW) certification
• Experience working directly or telephonically with populations utilizing OHP and Medicare
• 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 American Indian and Alaska Native 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 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.

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