Remote: This position has the possibility of being 100% Remote. Most of the positions at YCCO are hybrid, meaning they have the flexibility to work both remotely and/or in-person.

COVID-19 vaccination required for all YCCO employees except for an approved accommodation for medical or sincerely held religious belief. Please see Additional Information below.

Department: Health Systems FLSA Status: Exempt

Reports To: Integrated Health Management, Sr. Manager Physical Strength: Light (L)

Summary

This position is responsible for the successful oversight and management of the Care Management (CM) team and associated activities and deliverables. Working collaboratively across Yamhill Community Care (YCCO) teams as well as with external partners and the community. The Care Management Manager will manage a team that supports the triple aim and positive outcomes for YCCO members.

Learn more about Yamhill Community Care: click here

Essential Duties

• Ensures the integrated Care Management program meets Oregon Administrative Rules (OARs), Centers for Medicare & Medicaid Services (CMS), and contractual obligations.
• Monitors and supports the effectiveness and outcomes of the CM program.
• Effectively and efficiently manages a diverse CM workforce in a fast-paced, dynamic regulatory environment.
• Leads process improvement initiatives within the CM program, working with a variety of departments and multi-disciplinary staff.

Job Duties

Ensure the integrated Care Management program activities, meet OARs and contractual obligations. Includes, but is not limited, to the following:

• Assesses of and responds to the medical, social, and behavioral needs of YCCO members.
• Care Plan development and prioritization to transition members to optimal levels of health and self-management.
• Collaborates across providers and healthcare settings to ensure optimal quality outcomes for an assigned population.
• Transition of care interventions as required.
• Facilitates care coordination, self-management planning, discharge planning, and health education for an assigned population.
• Facilitates linkage to appropriate community resources to address social determinants of health.
• Adjudicate referrals and applies evidence-based clinical criteria to coordinate member care needs across all care settings.
• Ensures member communication and notices are composed in a manner consistent with regulatory standards.
• Seeks consultation as needed to support quality of care.

Supervision of Integrated Care Management Team

• Communicates with the team members daily/weekly/monthly, as appropriate, to support individual staff and the team’s ability to meet program deliverables and outcomes.
• Monitors and works with staff to be compliant with deliverables, required timelines, and other performance elements.
• Supports onboarding, training, and education across teams.
• Supports team’s adherence to Policies and Procedures set forth by the organization.
• Develops staff skills and monitors team members’ coordination of Interdisciplinary Team Meetings.
• Assists with developing and maintaining efficient and effective documented policies and procedures.

Oversight of Integrated Care Management Program Deliverables

• Ensures that Care Management documentation is entered in a clear, organized, and timely manner that is compliant with Oregon Revised Statutes (OAR) and contractual requirement.
• Develops and maintains policies and procedures.
• Monitors CM, quality, and risk concerns and refers to appropriate departments as applicable for follow up.
• Completes assignments, monthly statistics, and all reports per Department guidelines.
• Refers UM issues to the UR Program Manager, outcome manager(s), and/or UR physician advisor(s) in a timely manner.
• Participates in the preparation and submission of regulatory and contract required deliverables.
• Works closely with other YCCO departments to assist with audits and other deliverables, including the External Quality Review (EQR).
• Participate in performance improvement activities.
• Uses data to drive decisions and plan/implement performance improvement strategies related to CM activities.
• Leads process improvement initiatives within the CM program, working with a variety of departments and multi-disciplinary staff.
• Creates reports, displaying data and providing narrative analysis, to a variety of audiences.
• Leads and/or participates in development, implementation, and evaluation of quality and transformational initiatives as related to CM.

Management & Leadership

• Ensures program expectations and standards are clearly understood by unit staff.
• Provides staff with the training, tools, and resources necessary to carry out their work.
• Analyzes staffing needs and reorganizes work and assignments, as needed.
• Supervises assigned unit staff in a consistent manner.
• Evaluates unit employees’ performance both informally and formally and takes corrective action to address areas of opportunity.
• Performs human resource functions in collaboration with the Manager and Human Resources.

Essential Department & Organizational Functions

• Participates in the preparation and submission of regulatory and contract required deliverables.
• Works closely with other YCCO departments, including Health Plan Operations and Quality Assurance and Compliance, to assist with audits; including the External Quality Review (EQR), as needed.
• Proposes and implements process improvements.
• Meets deadlines for completion of workload.
• Demonstrates cooperation and teamwork.
• Provides cross-training on specific job responsibilities.
• Meets identified business goals that contribute to departmental goals.
• Maintains punctual, regular, and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Respectfully takes direction from Supervisor.
• Other duties as assigned.

Knowledge, Skills, & Abilities

• Ability to effectively apply advanced critical thinking and conflict resolution skills
• Knowledge of contract, regulatory, and survey standards (Medicare and Medicaid).
• Knowledge of health conditions, prioritized populations, and health systems.
• Knowledge of rapid-cycle process improvement.
• Demonstrate positive and professional written, verbal, and nonverbal communication skills.
• Demonstrate positive and professional interpersonal skills.
• Excellent organizational skills and ability to manage multiple tasks and timelines simultaneously, as well as to perform work with attention to detail.
• Ability to work independently, when needed, and to use sound judgment, anticipate next steps and be proactive.
• Excellent computer skills, including Microsoft Windows, Word, Excel, Outlook, PowerPoint, care management software platforms, and other software tools for analysis and presentation of CM related data.
• Ability to communicate effectively in all forms of communication.
• Ability to work in an environment with diverse individuals and groups.

Supervisory Responsibilities

Directly supervises employees in the Health Systems department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

Required:

• Bachelor’s degree in Nursing or Master’s degree in other Healthcare related field, including Behavioral Health.
• Three (3) + years’ experience supervising or leading teams.
• Two (2) + years' Care Management experience.

OR:

• Any combination of education and experience that would qualify candidate for the position.

Preferred:

• Five (5) years supervising or leading Care Management team.
• Experience with and/or knowledge regarding Utilization Management.
• Experienced in physical and behavioral health integration.
• Experience with Coordinated Care Organization (CCO)/Medicaid Managed Care.
• Experience with Care Management and the populations involved in case management.
• Experience in the use of Motivational Interviewing and Certification as a case manager.

Certificates, Licenses, and/or Registrations

Preferred:

• Licensed in the State of Oregon.
• ACM (Accredited Case Manager) through AMCA (American Case Management Association).
• CCM (Certified Case Manager) CCMC (Commission for Case Manager Certification).
• Board certification in Nursing Case Management (RN-BC) through ANCC (American Nurses Credentialing Center).
• Licensed Masters Social Worker (LMSW-ACP).
• Licensed Professional Counselor (LPC).

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this position. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand, walk, use hands and fingers, handle or feel, and reach with hands and arms. The employee is occasionally required to climb or balance, stoop, kneel, crouch or crawl. The employee may occasionally need to lift and/or move up to 25 pounds.

This position operates in a professional office environment and requires frequent use of standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Specific vision abilities required by this job include close vision, color vision, distance vision, depth perception, and ability to adjust focus. The noise level in the work environment is usually moderate.

This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.

Additional Information about COVID-19 Vaccination Requirements

To safeguard the health of our employees and their families; our members and visitors; and the community at large, YCCO requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious accommodation as a qualification of employment.

Job candidates that receive a contingent offer of employment from YCCO must provide proof of COVID-19 vaccination, along with a completed attestation that the documentation submitted is true and correct to Human Resources Department;

OR

Submit a completed request for accommodation form due to a medical reason or sincerely held religious belief to the Human Resources Department to begin the interactive accommodation process.