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.

Department: Health Systems FLSA Status: Exempt

Reports To: Health Systems Director Physical Strength: Light (L)

Summary

The Integrated Health Management (IHM) Sr. Manager is responsible for the successful oversight and leadership of Integrated Health Management (IHM), including integrated Utilization Management (UM) and integrated Care Management (CM) teams. The IHM Sr. Manager promotes strong internal and external relationships and consistently meets regulations and contract deliverables. Responsible for the ongoing development and maintenance of the Integrated Health Management business model and drive strategies for continuous quality improvement.

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Essential Duties

Job Duties

Leads Integrated IHM programs in a manner that ensures OARs and contractual compliance. Includes, but is not limited to the following:

• Supports a culture of quality assurance and investment in the Yamhill Community Care (YCCO) mission, vision, and strategic plan.
• Oversees health transformation efforts related to Health management programs.
• Represents YCCO across applicable State and system level activities and committees.
• Develops trust/credibility and collaborates with a broad range of internal and external partners.
• Directs the development of dashboards, and leverage data and other analytics to assure YCCO success in meeting benchmarks
• Collaborates with the YCCO Chief Medical Officer to facilitate clinically driven UM and CM outcomes and operational logistics meeting OAR and contractual requirements.
• Develops and maintains policies and procedures.
• Participates in department budget development in ensuring appropriate staff, budget and other resources are available to meet organizational strategic and business plan goals, and corporate policy and procedures.
• Ensures effective communication and collaboration with the Oregon Health Authority (OHA), community partners, service providers, committees, and staff.

Quality Management

• Leads process improvement initiatives within IHM, working with a variety of departments and multi-disciplinary staff.
• Develops and oversees CM and UM processes to ensure that activities, documentation, and reporting supports quality, timely, and compliant deliverables.
• Seeks consultation as needed, to support quality of care.
• Uses data to drive decisions and plans/implements performance improvement strategies related to UM activities.
• Creates reports, displaying data and providing narrative analysis, to a variety of audiences.
• Identifies and facilitates resolution of system process issues impeding UM functions. Identifies and resolves delays and obstacles as appropriate.
• Leads and participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff.

Oversight of Health Management Program Deliverables

• Ensures the preparation and submission of regulatory and contract required deliverables are completed in a timely fashion.
• Ensures that documentation is entered in a clear, organized, and timely manner that is compliant with OAR/ORS (Oregon Revised Statutes) and contractual requirement.
• Develops and maintains policies, procedures, and protocols.
• Ensures ongoing compliance monitoring of IHM functions.
• Completes assignments, monthly statistics, and all other required reporting.
• Monitors IHM for quality and risk concerns. Refer to appropriate departments as applicable.
• Participates in, and/or leads, assigned Committee and program activities.
• Works closely with other YCCO departments to assist with audits and other deliverables, including the External Quality Review (EQR).

Management & Leadership

• Trains, supervises, and evaluates performance of assigned staff.
• Provides department with ongoing understanding of the transformation, strategic plans, and operational direction of YCCO.
• Ensures adherence to department and organizational standards, policies and procedures.
• Ensures performance goals, expectations and standards are clearly understood by supervised staff.
• Performs human resource functions in collaboration with Human Resources
• 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.
• Maintains agreed upon work schedule.
• 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

• Demonstrate a working knowledge of regulatory and survey standards (Medicare, Medicaid, Joint Commission).
• Demonstrate a working knowledge of disease, including mental illness and addiction, and age specific impact.
• Demonstrate a working knowledge of rapid-cycle process improvement.
• Use Microsoft Word, Excel, PowerPoint, UM and CM software platforms, and other software tools for analysis and presentation of IHM related data.
• Demonstrate positive and professional written, verbal, and nonverbal communication skills.
• Apply advanced critical thinking and conflict resolution skills using creative approaches.
• Ability to utilize negotiation skills, which effectively promote constructive solutions.
• Work collaboratively and professionally across YCCO teams as well as with external partners and the community.
• Excellent interpersonal communication, problem-solving, and conflict resolution skills.
• Knowledge in areas of: Medicare and Medicaid UM regulations, McKesson InterQual, HERC Guidelines, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management.

Supervisory Responsibilities

Directly supervises employees in IHM. 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 Health Services, including Behavioral Health.
• Five (5+) years’ experience supervising or leading teams.
• Three (3+) years’ Utilization Management or Care Management experience.

OR:

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

Preferred:

• Eight (8+) years relevant experience.
• Five (5+) years’ experience with Utilizations Management or Care Management experience.
• Experienced in physical and behavioral health integration.
• Experience with Coordinated Care Organization (CCO)/Medicaid Managed Care.
• Equivalent combination of education and experience will be considered.

Certificates, Licenses, and/or Registrations

Preferred:

• 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).
• CPHQ (Certified Professional in Health Care Quality) through NAHQ (National Association of Health Care Quality).

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.