High Risk Triage Coordinator I

CareOregon

7d•$23 - $28•Remote

About The Position

This position provides clinical operations support, working closely with Population Health regional care teams to achieve team and strategic goals. The overall aim is to improve quality of care, coordinate care across the continuum, reduce hospital re-admissions, and increase access to advanced illness care. The position is responsible for identifying and triaging members and assignment of appropriate referrals. Core functions of the position include serving as a bridge between CareOregon and external partners, community-based organizations, and state governments, taking on special projects, supporting the broader Care Management Team’s strategic needs, and coordinating systems across a large regional area. NOTE: This is a remote position but you must reside in the Portland metro area.

Requirements

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

Nice To Haves

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

Responsibilities

Triage
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.
Program Coordination
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.
Data Tracking and Reporting
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.

Benefits

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.
CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.).
We also offer a strong retirement plan with employer contributions.
Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state.
Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility.
Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

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