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

Department:               Health Plan Operations                                         FLSA Status:                              Exempt (Salaried)

Division:                      Care Management                                                 Physical Strength:                     Light (L)

Reports To:                 Health Services Supervisor                                   Work Location Type:                  Hybrid

Supervisory Role:      No                                                                            Occasional Weekend Work:      No

Summary

The Clinical Support Specialist (CSS) will work in-person and remotely to perform all aspects of the outlined case management support duties, performing engagement and coordination activities at the individual, community, and health plan levels for chronically ill Medicaid members with diagnoses to include chronic kidney disease, diabetes, COPD, and cardiovascular disease, priority population members and members with mental health and substance use issues.

 This position is responsible for administering assigned tasks, performing health assessments, and escalating identified member services issues. Works in collaboration and continuous partnership with members, families / caregivers, clinical support staff, clinic providers, and community resources in a team approach, supports the patient’s ability for self-management and improve member outcomes. 

Essential Duties

1. Administers member identification and engagement.
2. Collaborates with YCCO staff and community partners to ensure positive outcomes for members and serves as a liaison between care managers, providers, and members to support comprehensive communication and education. 
3. Ensures documentation reflects clinical support activities performed and is aligned with regulatory requirements.

Job Duties

Member Identification Engagement

• Consults with colleagues and community partners to ensure all members requiring care coordination or case management services are readily identified by the CCO.
• Reviews and processes referrals, ensures appropriate monitoring, evaluates and reports on multi-agency referral and home visiting systems and makes appropriate referrals both internally and externally to appropriate departments / resources.
• Completes outreach calls to identified priority population members for specific case management programs.
• Provides direct member service including responding to incoming calls and routing to appropriate person/department.
• Directs and assists members in completing Health Risk Assessments to identify coordination needs and begin the care planning process.
• Advocates for members / families where member concerns are heard, access to providers is facilitated, and community resources are made available.
• Utilizes expertise to ensure identification and outreach to selected high-risk individuals by working with providers, partners, staff, and other care team members.
• Uses motivational interviewing to coach members towards improved healthcare behaviors. 
• Performs work that includes the member, family members, providers, and care team participants to evaluate participant’s health conditions, make recommendations to participant on preventative and follow-up care; and educating participants on condition(s) and risk, including when condition(s) are worsening.
• Generates and creates community confidence in YCCO programs and services by embracing and exhibiting the Vision and Mission of YCCO.
• Provides excellent customer service, meets the needs of clients while interacting in a respectful and culturally appropriate manner.

Collaboration & Education

• Takes independent actions to address members identified needs including, but not limited to: schedules provider appointments, arranges for transportation, verifies needed services are provided, refers to community resources and locates members.
• Represents the Plan, facilitates cross-setting communication including clinic providers, community partners, and member support teams.
• Proactively establishes trusting relationships through regular contact, participates on Multi-Disciplinary Team, consults with other professionals in the areas of oral and behavioral health, pharmacists, primary care, etc.
• Educates and ensures collaborative communication among providers from all networks (physical, behavioral, dental, transportation, traditional health workers.)
• Drives person-centered services by educating self and others of YCCO programs and services and other resources available for populations served.
• Educates members in navigating the health care delivery system, gains access to appropriate community resources, negotiates transitions in their health care, and determines ways to improve self-management.
• Generates correspondence with clinical staff, providers, and members of the care team to meet turnaround time requirements.

Reporting & Documentation Management

• Contributes to the creation of care plans and the implementation of complex and integrated plans of care under the direction of clinical care coordination staff.
• Identifies and collects all required documentation as set forth by Federal, State, funding regulations, and Agency policy.
• Serves as a Mandatory Reporter of suspected abuse of vulnerable populations as required by policy and regulation.
• Maintains a high level of accuracy when processing and sharing information according to privacy regulations.
• Protects clients and reduces YCCO risk by modeling and following policies, regulations, and requirements of Oregon Health Authority and YCCO.

Essential Department & Organizational Functions

• 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 and implements process improvements.
• Meets deadlines for completion of assigned responsibilities and projects.
• Maintains agreed upon work schedule with punctual, regular, and predictable attendance.
• 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.
• Performs other duties as assigned.

Knowledge, Skills, & Abilities

• Ability to assess a situation and seek or determine appropriate resolution, accept managerial direction, and feedback, and tolerate and manage stress.
• Ability to use good judgment, takes personal initiative and uses discretion in performing job responsibilities including planning, prioritization, and organizational skills.
• Ability to make observations concerning patients’ general health conditions.
• Ability to work efficiently as a member of a care team.
• Ability to establish and maintain collaborative relationships with all levels of colleagues and the general public.
• Ability to follow policy and procedure while working independently and to seek and offer assistance when needed.
• Ability to work well with others, to hear and understand differing points of view, and to be able to articulate and explain situations based on perspective of client.
• Ability to use various assessment instruments.
• Highly proficient in spelling, grammar, and punctuation.
• Knowledge of and experience working with individuals with chronic conditions, including an understanding of issues that may prevent access or use of available services. 
• Knowledge of principles and procedures of record keeping and reporting.
• Knowledge of rules regarding mandatory reporting.
• Employees in this position may be subject to drug screening, as well as a physical and vaccination assessment.
• Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with others.
• Excellent organizational skills including ability to handle multiple priorities and demands simultaneously in a dynamic work environment while maintaining high attention to detail and accuracy.
• Ability to work independently, 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, and Outlook.
• 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 

This position has no supervisory responsibility.

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:

• Minimum two (2) years of experience in healthcare setting including experience with case management, disease management, and/or quality improvement departments.

     OR:

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

Preferred:

• Bilingual (English/Spanish).
• Associates or Bachelor’s in Health related field.
• Knowledge of Oregon Medicaid requirements prior authorization and/or utilization review services.

Certificates, Licenses and/or Registrations

This position does not require any certificates, licenses, or registrations. 

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.