OHSU Health Services is committed to the ongoing journey of being an anti-racist organization that acknowledges the enduring impacts of historical injustices on health; addresses clinical, social, and structural systems and conditions that undermine health and wellness; strives to become a culturally-proficient workplace that reflects the communities served; and fosters an environment of belonging, respect, and inclusion where everyone feels empowered and safe to bring their full, authentic selves to the work. Change requires individuals at all levels of the organization to be proactive in redistributing resources and power equitably by restructuring policies, clinical and financial strategies, culturally sensitive data analysis and the way data is used. OHSU Health unequivocally expects its staff and leadership to fully support this mission in these efforts.

 

The Care Integration Specialist serves as an integral member of the Care Integration and Coordination multi-disciplinary team of OHSU Health Services. This position assists in the care coordination process working closely with the Integrated Community Care Managers, Member, providers and facilities and/or services. The Care Integration Specialist assists in performing initial basic intake and social determinants of health assessments of Members, accessing necessary services and supports, community resources (such as housing and transportation), and provides navigation support for the Member. The Care Integration Specialist applies knowledge and experience to perform a wide range of supportive activities and determines how best to use resources to meet schedules and goals, and enhances the quality of Member management by supporting continuity of care and cost effectiveness through whole person care management, care integration, and care coordination across the continuum of health care services.

 

Wage Range: $28.53 - $38.57 per hour

• Performs basic and social determinants of health assessments of Members coming into OHSU Health Services to help in determining future care coordination/care management needs and potential support resources. Collaborates closely with members of the Care Integration and Coordination team in facilitating care coordination referrals and access to services as may be indicated for the Member through outreach to assist in navigating the health care system. Works with the Member in selecting a primary care physician if needed. Based on results of assessments, assists Member in identifying resources and supports that will provide assistance to the Member.
• Collaborates closely with the Member’s medical and health community-based providers (primary care provider (PCP), specialist provider, behavioral specialists, or others as may be indicated) to help facilitate the Member’s plan of care being followed. Fosters positive and professional relationships and acts as a liaison with internal and external customers to ensure effective working relationships.
• Composes and prepares confidential correspondence, reports and related materials to support the Care Integration and Coordination process. Routinely documents all Member interactions and Member engagements in the EMR to ensure a longitudinal record is maintained of all Member interactions. Collects clinical and engagement data and enters information into the electronic medical record (EMR) for tracking and metric purposes. Maintains medical record confidentiality at all times through the proper use of computer passwords, maintenance of secure files; adherence to HIPAA guidelines and policies. Ensures day-to-day processes are conducted in accordance with nationally accepted standards (NCQA, URAC and other regulatory standards).
• Monitors and evaluates the services and community-based resources necessary to respond to the member’s individual health care needs. Assists to maintain the OHSU Health Services Community Resource Directory.
• Utilizes proper telephone and personal etiquette and judicious use of other verbal and written communications, following OHSU and OHSU Health Services policies, procedures and guidelines. Follows OHSU and OHSU Health Services telecommuting policies and procedures as a member of the Care Integration and Coordination Program staff.

Education:

• Associate degree in a healthcare related field that may include such areas as nursing, community health education, psychology or sociology.

Experience: 

• Minimum two (2) years of healthcare setting, such as hospital, clinic or health plan experience.

Job Related Knowledge, Skills and Abilities: 

• Ability to work collaboratively with a multi-disciplinary team of health care providers.
• Assists in the care management process with knowledge of accessing referral agencies and organization to assist with member needs.
• Able to prioritize and identify those issues and/or patient items needing immediate assistance.
• Acts as a primary contact in assisting the member in navigation of health care needs.
• Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.
• Organizational skills with the ability to handle multiple tasks and/or projects at any one time.
• Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from different departments and/or agencies within and outside OHSU and OHSU Health Services.
• Strong telephonic communication and interviewing skills.
• Decision-making skills with the ability to investigate and weigh alternatives, integrate data, and select the most appropriate course of action that meets the best-interest needs of the member and provides the greatest benefit to the organization.
• Creative- and critical-thinking skills with the ability to consider new ideas that will lead to process and team improvements.
• Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time.
• Problem-solving skills with the ability to look for the root cause of issues and implementable, workable solutions.
• Interpersonal skills with the ability to work in a fast-paced environment with the ability to participate as an independent contributor with little direct supervision or as an active team member depending on the circumstance or need.
• Attention to detail and a track record of producing high-quality and accurate work that reflects well on the organization.
• Knowledge and experience in working with computer systems and electronic medical records.
• Able to travel within the tri-county area with an active and unrestricted driver’s license, reliable transportation and active automobile insurance coverage.

Benefits:

• Two raises per year – One at anniversary date and one across the board annual increase
• Healthcare Options - Covered 100% for full-time employees and 88% for dependents, and $25K of term life insurance provided at no cost to the employee
• Two separate above market pension plans to choose from
• Vacation- up to 200 hours per year depending on length of service
• Sick Leave- up to 96 hours per year
• 8 paid holidays per year
• Substantial Tri-met and C-Tran discounts
• Additional Programs including: Tuition Reimbursement and Employee Assistance Program (EAP)

Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.