Case Manager
Roseburg, Oregon
Health Plan Operations – Medical Management /
Full-Time-Exempt /
Hybrid
At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together.
Umpqua Health strongly encourages applications from candidates of color as well as veterans, aiming to foster a work environment that is linguistically and culturally diverse and inclusive. Please note that at this time, Umpqua Health does not offer visa sponsorship.
Umpqua Health is looking to add a dedicated and driven Behavioral Health Case Manager to the team! The Behavioral Health Case Manager is responsible for coordinating the care of Oregon Health Plan (OHP) members enrolled with Umpqua Health Alliance. Care coordinators prioritize members who have high health care needs, including members with complex behavioral concerns, severe and persistent mental illness, and substance use disorders. The members may be receiving facility based, in-home or community-based psychiatric services. Behavioral Health Care Coordinators possess clinical expertise in behavioral health conditions and experience navigating the continuum of behavioral health care delivery. to provide coordination that is member focused, strengths based, trauma-informed, and culturally and linguistically appropriate.
Your Impact:
- Engage members in locations most comfortable to them when discussing care coordination (i.e.: in-home visit, synchronized video, community-based location).
- Provide care coordination support and coaching to members, which may include developing motivational strategies to promote their progression through the stages of change in alignment with evidence-based medicine and best practices.
- Utilize a trauma-informed approach to provide member-centric care and support.
- Meet with members and their families to assess needs and identify risk factors including physical condition, behavioral issues, mental status, social support system availability, and relationship with providers.
- Utilize assessment information to develop an individualized care plan to address member identified needs, minimize health risk(s), and improve health outcomes.
- Advocate and assist members in navigating the health care system and accessing community resources.
- Connect members with professional services and maintain consistent communication, assessing their progress toward care plan goals, and making changes to the treatment plans as needed.
- Track and monitor referrals, detail purpose and outcomes from home visits, and record all other relevant interactions with members.
- Maintain accurate and current documentation for members that captures all case management engagement activities to effectively coordinate care.
- Facilitate member transitions through the continuum of care, ensuring member placements are grounded in best practices and medical necessity.
- Assist in transition/discharge planning for members discharging from acute care settings or those who are transitioning from long term care, the Oregon State Hospital or other residential facilities to ensure a smooth transition back to community-based supports.
- Ensure discharge/transition plans are evaluated holistically from physical and behavioral health perspectives.
- Ensure members on the state hospital Ready to Transition (RTT) list are prioritized for referral into appropriate transition setting through collaboration with and community partners.
- Coordinate care for members receiving care or transitioning outside of service area as required.
- Provide community outreach and/or education on UHA’s Behavioral Health Care Coordination program.
- Work effectively and diplomatically within multidisciplinary care teams and actively participate in Interdisciplinary Team (IDT) Meetings, which include internal and external participants.
- Work closely and collaborate with behavioral health treatment providers, crisis services, Developmental Disability, APD, DHS, etc.
- Maintain consistent and reliable communication with members and community partners to promote member success in improving health outcomes through collaborative integrated care planning.
- Coordinate emergency assistance for members by communicating with members and vendors, collecting, and completing necessary paperwork and vouchers, and submitting requests for Flexible Spending to utilization management.
- Maintain updated knowledge of the Oregon Administrative Rules (OAR) governing OHP and Care Coordination. Follow Medicare guidelines, the appeals and grievance process, and the members’ rights and responsibilities as stated by the Division of Medical Assistance Program (DMAP aka HSD) Oregon Health Authority (OHA) and Centers for Medicare and Medicaid Services (CMS).
- Educate members on their rights and responsibilities, including consent required for release of protected health information necessary to coordinate requested care.
Your Credentials:
- Minimum of a bachelor’s degree in behavioral science, social science or related field or a license in a field that qualifies you to take the Certified Case Management (CCM) exam (for example: RN, LCSW, LPC, CRC, CDMS, MA eligible for CCM certification).
- Must be a Certified Case Manager (CCM) within one year.
- Two years’ experience as a Case Manager for Behavioral Health.
- To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 50 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- No suspension/exclusion/debarment from participation in federal health care programs (e.g. Medicare/Medicaid).
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
