Care Coordination Manager

This position is responsible for managing care coordination services, assuring a personalized, timely, comprehensive, and cost-effective approach to the provision of medical and dental health related services. This position is also responsible for overseeing compliance of state and federal requirements for associated work, including contractual requirements with the Medicaid and Medicare Advantage plans. This position will support and collaborate with the department leadership team to ensure a comprehensive and cost-effective approach to the provision of medical and dental related services, a key component of which will be focused on members with special healthcare needs by performing the following duties.

• Manages all functions of the medical Case Management team, specifically medical and dental case management and care coordination for Medicaid and Medicare Advantage members.
• Leads the management of contract deliverables and compliance related to care coordination and case management.
• Leads the process for identifying members with catastrophic, complex, and chronic medical management needs and leads assessment and delivery of potential options and alternatives for management of specific health related needs.
• Demonstrates knowledge of the Medicaid and Medicare Advantage benefit packages and the ability to administer those benefits.
• Oversees the coordination of care across a continuum of care settings to assure appropriate care and achievement of optimal outcomes.
• Ensures a coordinated approach to care planning and the appropriate use of health care resources.
• Supports collaboration of the care coordination team with the utilization review team to identify appropriate alternative levels of care for members.
• Facilitates orderly and timely transition from one care setting to another.
• Prevents lengthy hospitalization by ensuring effective and efficient care coordination to optimize outpatient care and remove barriers to discharge, thus avoiding costs and risks encountered in institutional settings.
• Oversees and ensures the care coordination team is identifying the appropriate level of care quickly and works to remove barriers to discharge.
• Leads the transition of care processes by reviewing Emergency Department and Inpatient Hospitalization reports daily and initiates care coordination as appropriate.
• Reviews reports on high-cost utilization by individual members, including emergency department, hospital costs and readmissions, and leads care coordination efforts to reduce costs for those members.
• Assists in barrier identification and resolution.
• Collaborates with other departments, providers, and community partners to improve communication and processes.
• Supports the work of the Quality Department to improve performance on Oregon Health Plan and CMS Stars quality measures where applicable.
• Attends and participates in meetings with department managers for primary care clinics, hospitals, Skilled Nursing Facilities, and local DHS to facilitate care coordination and access to care.
• Participates in process improvement projects and maintains department operating instructions and procedure manuals related to care coordination.
• Maintains confidentiality and complies with HIPAA rules and regulations.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with member and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
• Respectfully takes direction from manager.

EDUCATION and/or EXPERIENCE

Bachelor's degree from a four-year college or university in a related field; and three to five years related experience and/or training; or equivalent combination of education and experience.

COMPUTER SKILLS

Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.

CERTIFICATES, LICENSES, REGISTRATIONS

A valid Oregon Registered Nursing (RN) license is required. Case Management certification (CCM) is preferred.

We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

License/Certification:

• Case Management Certificate (Preferred)

Ability to Commute:

• Klamath Falls, OR 97601 (Required)

Work Location: In person