<p>Dental Outreach and Care Coordinator</p> <ul> <li>-------------------------------------------------------------- </li></ul> <p>This position is responsible for providing outreach, dental care coordination and cross-system, population health coordination for the organization's dental and oral health benefits. Core work involves providing care coordination and case management for dental members including assessing member needs and coordinating with providers and members. This includes internally assigned and outbound case management and navigational support for dental members, as well as partnership with internal teams relating to cross disciplinary care needs for individual members. This Dental Outreach and Care Coordinator works directly with members to support any identified health needs with a particular emphasis on oral health, to ensure dental benefit and dental provider access awareness for members and their families, and to support navigation and coordination to dental providers or other care teams as needed to establish care. This position also partners with internal teams and external partners (e.g., OHA/Ombudsperson, Health Share, Physical Health plan, NEMT, DCOs, etc.) in assuring timely access to dental care, maintaining continuity of care, and optimizing member well-being. This position requires critical thinking, time management, strong written and verbal communication skills, and independent judgment as well as comfort working with the organization's most vulnerable members.</p> <p>NOTE: This position requires residing in the Portland metro area.</p> <p>Estimated Hiring Range:</p> <p>$28.81 - $35.22</p> <p>Bonus Target:</p> <p>Bonus - SIP Target, 5% Annual</p> <p>Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.</p> <ul> <li>-------------------------------------------------------------- </li></ul> <p>Care Coordination and Case Management (Member and Population Health)</p> <ul> <li>Provides care coordination and case management support and clinical, navigational, and operational dental content expertise to interdisciplinary CareOregon departments and teams (e.g., BHCC, HRS, RCT); supports interdisciplinary care plan development. </li><li>Receives dental care coordination referrals from members, providers, community partners, and internal CareOregon departments and teams. </li><li>Assesses and identifies dental health care coordination needs. </li><li>Partners with Dental Director to coordinate dental services on assigned cases. </li><li>Identifies risk factors and service needs that may impact member outcomes and address appropriately. </li><li>Utilizes assessment information to develop and implement individualized dental health care coordination plans in collaboration with member, providers and other relevant parties for assigned caseload. </li><li>Provides intensive cross-disciplinary care coordination and dental case management for complex dental members; participates in regional care teams and supports medical members with complex dental needs. </li><li>Facilitates and fulfills dental case management between CareOregon and delegated dental plan partners and for targeted member populations as needed to meet member needs. </li><li>Provides warm handoff of members with complex medical or behavioral health needs to appropriate care coordination staff in addition to coordination of the member's oral health needs. </li><li>Supports complex referrals needing special coordination and case management. </li><li>Works with COD network, CCO, and delegated partner dental plans to meet key care coordination, case management, and clinical initiatives for targeted member populations; ensures follow-up and monitoring of delegated entity care coordination. </li><li>Identifies and supports population cohorts and individual members with unmet oral health needs; collaborates with medical and behavioral health teams to coordinate care for members with unmet overall health needs. </li><li>Supports operational implications and implementation of care coordination software across the organization and regional or external care coordination platforms. </li><li>Identifies, tracks, and reports members or member cohorts needing care coordination or meeting criteria for key incentive metrics using care management platforms. </li><li>Maintains care coordinator documentation and records, using a variety of mechanisms, tools and platforms. </li><li>Leads and reports DHS care coordination and case management; escalates to leadership, as needed. </li><li>Escalates to appropriate department/supervisor/Dental Director and acts as a liaison in partnership with clinical staff to report oral health outcomes and care coordination trends. </li><li>Uses motivational interviewing to coach members toward improved oral health care behaviors and self-management. </li></ul> <p>Member Outreach and Engagement</p> <ul> <li>Conducts outreach to members and assures ideal PDP assignment, shares benefit information, importance of oral health to overall health and provides navigational support, particularly as members are identified through programs and initiatives (Member dismissals, children newly placed into foster care, members with special health care needs). </li><li>Assists members with dental benefits and navigation; works with providers and delegated partners and provides customer service to resolve complex member-related issues. </li><li>Addresses members' navigation needs and identify potential resources while balancing cultural factors, social determinants, and member autonomy. </li><li>Ensures timely resolution of elevated member issues or feedback. </li><li>Works with members, providers, and customer service representatives to resolve members' dental-related issues. </li><li>Takes independent actions to address members' identified needs including, but not limited to: scheduling provider appointments, arranging for transportation, arranging for an interpreter when needed, confirming authorization/referral is in place, assisting with Health Related Services Flex requests, verifying needed services are provided, and locating members. </li><li>Utilizes care management software effectively for documentation, care coordination triage and member outreach. </li><li>Inputs information into the centralized or dental specific care coordination platforms and document all related activities. </li></ul> <p>Compliance and Administration</p> <ul> <li>Maintains compliance with Coordinated Care Organization requirements. </li><li>Completes initial and subsequent documentation of care coordination activities in compliance with applicable policies/guidelines. </li><li>Maintains working knowledge of OHP dental benefits. </li><li>Reports member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. </li><li>Participates in quality and organizational process improvement activities and teams as assigned. </li><li>Participates in work-related continuing education when offered or directed. </li><li>Documents all encounters in an accurate and timely manner in accordance with HIPAA laws, as well as internal policies and procedures. </li></ul> <p>Dental Team Support</p> <ul> <li>In partnership with oral health integration staff, supports network with member outreach strategies and initiatives. </li><li>Supports oral health promotion and escalation from across the organization. </li><li>Partners with Dental Referral and Access Coordinator on complex referrals or high-risk members. </li><li>Provides back-up Dental Referral and Access Coordinator supplemental support, as needed. </li><li>Contributes to continuous process improvement through participation in team huddles, training, departmental, team, and organizational meetings. </li><li>Other duties as assigned to support the work of the dental team. </li></ul> <p>Organizational Responsibilities</p> <ul> <li>Perform work in alignment with the organization's mission, vision and values. </li><li>Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. </li><li>Strive to meet annual business goals in support of the organization's strategic goals. </li><li>Adhere to the organization's policies, procedures and other relevant compliance needs. </li><li>Perform other duties as needed. </li></ul> <p>Experience and/or Education</p> <p>Required</p> <ul> <li>Expanded Function Dental Assistant (EFDA) certification or equivalent clinical experience </li><li>Minimum 3 years' experience in the dental healthcare setting with a combination of patient care and other experiences, including dental health insurance, treatment plan or case presentation, care coordination, front office and dental clinic operations, dental scheduling, coding, metrics, referral, and/or insurance authorization processes </li></ul> <p>Preferred</p> <ul> <li>Experience interviewing patients and/or members for health information </li></ul> <p>Knowledge, Skills and Abilities Required</p> <p>Knowledge</p> <ul> <li>Knowledge of clinical dental care, dental procedures and clinical workflow, dental patient care in the clinic setting and dental patient care management </li><li>Understanding of the relationships and co-morbidity of oral health and systemic health </li><li>Knowledge of the Oregon Health Plan and Medicaid Dental benefits </li><li>Knowledge of covered/non-covered dental services and OARs </li><li>Knowledge of dental terminology and dental coding </li><li>Understanding of dental provider networks </li><li>Familiarity with dental clinic and financial operations </li></ul> <p>Skills and Abilities</p> <ul> <li>Ability to discuss dental procedures and treatment plans and options with the patient and interdisciplinary clinical or care coordination teams </li><li>Ability to assess, synthesize information and develop cohesive care plans in partnership with the member </li><li>Ability to provide dental triage for patients/members </li><li>Exceptional interpersonal and organizational skills that foster collaboration and problem-solving </li><li>Excellent written and verbal communication skills, including motivational interview skills </li><li>Exceptional customer service skills and ability to work directly with members </li><li>Ability to understand common needs of members </li><li>Ability to effectively solve unique problems as they arise or identify when to escalate issues to appropriate department/supervisor </li><li>Ability to work effectively across multiple departments and health disciplines </li><li>Ability to develop and maintain excellent professional working relationships with PDPs and specialists </li><li>Ability to be accountable and have initiative </li><li>Ability to support and comply with organizational policies, procedures, and guidelines </li><li>Ability to work effectively with diverse individuals and groups </li><li>Ability to learn, focus, understand, and evaluate information and determine appropriate actions </li><li>Ability to accept direction and feedback, as well as tolerate and manage stress </li><li>Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day </li></ul> <p>Working Conditions</p> <p>Work Environment(s): ? Indoor/Office ? Community ? Facilities/Security ? Outdoor Exposure</p> <p>Member/Patient Facing: ? No ? Telephonic ? In Person</p> <p>Hazards: May include, but not limited to, physical and ergonomic hazards.</p> <p>Equipment: General office equipment</p> <p>Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.</p> <p>Work Location: Work from home</p> <p>Schedule: May include occasional work outside regular business hours to provide member support.</p> <p>We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.</p> <p>We are an equal opportunity employer</p> <p>CareOregon is an equal opportunity employer.? The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.</p>