Location: Hybrid. Most of the positions at YCCO are hybrid, meaning they have the flexibility to work both remotely and/or in-person at YCCO's office in McMinnville, OR.

Department:    Health Plan Operations                                FLSA Status:             Exempt

Reports To:      Nursing Director - RN                        Physical Strength:    Light (L)

About Us:  Yamhill Community Care is a nonprofit coordinated care organization dedicated to managing the healthcare for Medicaid members, covered under the Oregon Health Plan, in Yamhill County, as well as parts of Washington and Polk Counties. Our mission is to improve the quality of life of the communities we serve by coordinating effective care. Beyond healthcare, we also provide an Early Learning Hub, supporting families and children with essential resources and programs for early childhood development. Together, we're building a unified healthy community that celebrates physical, mental, emotional, spiritual, and social well-being.

Learn more about Yamhill Community Care:  click here

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 quadruple aim and positive outcomes for YCCO members.

Essential Duties

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

Job Duties

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

• Collaborates across providers and healthcare settings to ensure optimal quality outcomes for an assigned population.
• Assists to facilitate transition of care interventions as required.
• Facilitates care coordination, self-management planning, discharge planning, and health education for an assigned population working with Care Managers in addressing member needs.
• Performs the functions of a Care Manager when there is an operational need working in collaboration with the CM team.
• Facilitates linkage to appropriate community resources to address social determinants of health.
• Adjudicates referrals and applies evidence-based clinical criteria to ensure care is coordinated 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 ensure compliance with OAR deliverables, required timelines, and other performance expectations and standards.
• Facilitates onboarding, training, and education across teams.
• Supports team’s adherence to Policies and Procedures set forth by the organization.
• Develops and supports staff skills and monitors team members’ coordination of Interdisciplinary Team Meetings.
• Monitors for staff adherence to departmental 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 Administrative Rules and contractual requirements.
• Develops and maintains efficient and effective departmental policies and procedures consistent with regulatory, OAR, CMS and contractual requirements.
• Monitors the delivery of care management services for quality and risk concerns and refers to appropriate departments as applicable for follow up.
• Completes assignments, monthly statistics, and all reports per department guidelines within the timelines expected.
• Refers utilization management issues to the Health Plan Utilization Manager and collaborates in the resolution of reported issues.
• Facilitates and takes the lead in preparation and submission of regulatory and contract required deliverables related to care coordination and care management.
• Participates in performance improvement activities, which may include leading these activities for those involving care coordination and CM.
• Uses data to drive decisions and plan/implement performance improvement strategies related to care management activities.
• Leads process improvement initiatives within the CM Program, working collaborative with the Nursing Director - RN, and a variety of departments and multi-disciplinary staff.
• Creates reports displaying data and provides narrative analysis to a variety of audiences.
• Leads and/or participates in development, implementation, and evaluation of quality and transformational initiatives as related to the delivery of CM services.

Management & Leadership

• Ensures program expectations and standards are clearly understood by department staff.
• Provides staff with the training, tools, and resources necessary to carry out the work.
• Analyzes staff productivity and quality, reorganizing and distributing work assignments needed.
• Supervises assigned department staff in a consistent manner.
• Evaluates department employees’ performance both informally and formally and takes corrective action to address areas of opportunity.
• Performs human resource functions in collaboration with the Health Plan Operations Sr. Director, Nursing Director - RN, Supervisor and Human Resources.

Essential Department & Organizational Functions

• Responds promptly to requests from other departments, administration and peers.
• Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members.
• Participates in the preparation and submission of regulatory and contract required deliverables.
• Works closely with other YCCO departments, including Compliance, to assist with audits; including the External Quality Review (EQR), as needed.
• Proposes, implements and monitors process improvement activities within the department.
• Meets deadlines for completion of assigned work, and departmental and regulatory deliverables.
• Maintains punctual, regular, and predictable attendance following organizational guidelines.   
• Attends in person Annual Company Conference in McMinnville, OR, typically held in the fourth week of September.
• Demonstrates cooperation and teamwork using a professional and respectful demeanor.
• Provides cross-training on specific job responsibilities.
• Meets identified goals that contribute to departmental goals.
• Works collaboratively in a team and matrixed (cross-department) environment with a spirit of cooperation.
• Respectfully takes direction from Supervisor and administrative leadership.
• Performs 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, in a dynamic work environment while maintaining high attention to detail and accuracy.
• Ability to work independently, when needed, and to use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
• 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 both professionally and effectively in all forms of communication.
• Ability to work in an environment with diverse individuals and groups.
• Ability to remain flexible, positive, and adaptable.
• Ability to work across the YCCO region and to work remotely, as needed.

Supervisory Responsibilities

Directly supervises employees in the Care Management team within Health Plan Operations department. Carries out supervisory responsibilities in accordance with the organization's policies, procedures and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; coaching and providing performance improvement plans; 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 of experience supervising or leading teams.
• Two (2) + years of 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 population involved in case management.
• Experience in the use of Motivational Interviewing 

Certificates, Licenses, and/or Registrations

Required:

• Valid, unrestricted Oregon Registered Nurse (RN) license
• Certified Care Manager (CCM) 

OR:

• Achievement of certification (CCM) within 12-24 months of hire.

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.