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Health Services Specialist II | Hybrid: Flexible Remote & In-Person

Yamhill Community Care

Health Services Specialist II | Hybrid: Flexible Remote & In-Person

National
Full Time
Paid
  • Responsibilities

    +--------------------+--------------------+--------------------+--------------------+ | DEPARTMENT: | Health Services | FLSA STATUS: | Exempt | +--------------------+--------------------+--------------------+--------------------+ | REPORTS TO: | Health Services | PHYSICAL STRENGTH: | Light (L) | | | Manager - RN | | | +--------------------+--------------------+--------------------+--------------------+

     

    +--------------------------------------------------------------------------+ | SUMMARY | | | | The Health Systems Specialist II is responsible for supporting the | | whole-person health care system within Yamhill Community Care (YCCO). | | This position will work collaboratively within the Health Services team | | to monitor and support contracted entity’s utilization management, | | grievance and appeals and care management activities. It includes | | functioning as a point of contact for State and Community Mental Health | | Programs (CMHP) related to care management tracking and support related | | to high-risk members. Core areas of focus include developing | | relationships between behavioral health partners, providers, care | | managers and Oregon Health Authority (OHA). Facilitating and maintaining | | communication and collaboration among all key partners is crucial to | | success in this role. This position requires regular monthly | | participation at OHA’s system of care and quality meetings to provide | | direction to YCCO utilization and care programs for behavioral health | | services. Additionally, this position is responsible for supporting | | coordination around complex members and provide specific expertise to | | Health Services activities to align with healthcare transformation, | | strategic goals, and defined CCO 2.0 member-focused initiatives. | | | | ESSENTIAL DUTIES | | | | Program | | | | - Actively follows behavioral health best practices and professional | | code of conduct/ethics. | | - Functions as a matrixed member of various project and task teams to | | develop, strengthen, and expand access to robust, high value health | | services within YCCO’s service areas. | | - Provides Behavioral Health subject matter expertise and experience | | to strengthen the behavioral health system and the overall | | healthcare system. | | - Provides content expertise and technical assistance to YCCO’s | | behavioral health and physical health provider organizations. | | - Develops trust/credibility and effective communications within YCCO | | and external partners and providers. | | - Provides clinical and other support for innovative initiatives to | | support delivery system transformation. | | - Develops content expertise and technical assistance to YCCO’s | | behavioral health and physical health provider organizations. | | - Protect clients and reduce YCCO risk by modeling and following | | policies, regulations, and requirements of program and YCCO. | | | | Department | | | | - Self-directed ability to function with minimal oversight from | | supervisor daily. | | - Assists with the design and development of processes to ensure | | compliance with contract requirements including, but not limited to | | access, quality, program integrity, quality of clinical care, | | utilization, and compliance with OARs and other regulatory | | standards, as assigned. | | - Prepares and adds valuable content to bimonthly YCCO | | multi-disciplinary team meetings with staff and partners. | | - Develops weekly work plans to ultimately aim at quarterly and annual | | goals for reporting on OHA directed deliverables. | | - Serve as a Mandatory Reporter of suspected abuse of vulnerable | | populations according as required by policy and regulation. | | - Maintain and share information according to privacy regulations. | | - Facilitate community confidence in YCCO programs and services by | | embracing and exhibiting the Vision and Mission of YCCO. | | - Develop and promote person centered services by educating self and | | others of YCCO programs, services, and other resources available. | | - Prepares reports, performs special projects and other documents | | as assigned. | +--------------------------------------------------------------------------+

    JOB DUTIES

    • Assists team members and offer suggestions to improve processes, culture, and/or work environment.
    • Adheres to YCCO policy and procedures and standards of operations.
    • Maintains punctual, regular, and predictable attendance.  
    • Works collaboratively in a team environment with a spirit of cooperation.
    • Respectfully accepts direction from leadership.
    • Other duties as assigned.

    ESSENTIAL DEPARTMENT & ORGANIZATIONAL FUNCTIONS

    • Demonstrates cooperation and teamwork.
    • Demonstrates a professional demeanor.
    • Works effectively in a very fast-paced environment.
    • Adheres to established internal control procedures for all contract functions.
    • Ability to focus on and comprehend information, learn new skills and abilities, quickly assess a situation, and seek appropriate resolutions.
    • Proposes and implements process improvements.
    • Meets deadlines for completion of assigned responsibilities and projects.
    • Provides cross-training on specific job responsibilities.
    • Meets identified goals that contribute to overall departmental goals.
    • Ability to tolerate and manage stress.

    KNOWLEDGE, SKILLS, & ABILITIES

    • Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
    • Ability to identify complex problems and review related information to develop and evaluate options and implement solutions.
    • Strong organizational skills with the ability to manage multiple tasks simultaneously.
    • Ability to problem solve, analyze, and provide written documentation of analysis.
    • Ability to communicate project status and issues to manager in a timely manner.
    • Ability to remain flexible, positive, and adaptable.
    • Ability to build productive working relationships, problem solve and resolve conflicts successfully.
    • Excellent verbal and written communication, facilitation, and customer service skills.
    • Ability to work in an environment with diverse individuals and groups.
    • Ability to function as an influential communicator and creative problem solver.
    • Ability to work independently absent explicit directions, using excellent judgment and attention to detail.
    • Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with coworkers and others.
    • Ability to use Microsoft Office.
    • Knowledge of rules regarding mandatory reporting.

    SUPERVISORY RESPONSIBILITIES

    This position has no supervisory responsibilities.

    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 (5) years of related clinical or system work.
    • Bachelor’s degree in social work, public health, or another related field.
    • Skills in group facilitation, community organizing or systems-thinking.

    Preferred:

    • Master’s degree in health care administration, social work, or related healthcare field.
    • Experience in community behavioral health direct service.
    • Experience in quality and/or project management.
    • Knowledge of managed care, Oregon Health Plan (OHP) benefits, Oregon Administrative Rules (OAR), Oregon Statute (ORS) or CCO requirements.

    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.