Career Center

General Statement of Duties

This position is responsible for providing dental case management for the organization’s dental members.  Core work involves 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 position works with members to support any identified health needs with a particular emphasis on oral health needs, 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.  Key partners in this process are the member and relevant family/caregivers, healthcare providers, community partners, and internal staff and programs.  This position also assists with provider relations activities for specialty providers, as well as assists with customer service and general support to the dental team as needed.

Essential Position Functions

Case Management and Member Outreach

• Provides dental case management for targeted member populations; assists members with dental benefits and navigation.
• 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 (e.g., diabetes, metrics, ED/Premanage, D3, etc.).
• Works with COD network to meet key care coordination, case management and clinical initiatives for targeted member populations (e.g., PreManage, prenatal, diabetics).
• Supports members with unmet oral health needs; collaborates with medical and behavioral health teams to coordinate care for members with unmet overall health needs.
• Tracks and reports members needing dental case management for key incentive metrics using care management platform.
• Maintains care coordinator documentation and records, using a variety of mechanisms, tools and platforms.
• Inputs information into the centralized or dental specific care coordination platforms and document all related activities.
• Utilizes care management software effectively for documentation, care coordination triage and member outreach.
• Addresses members’ navigation needs and identify potential resources while balancing cultural factors, social determinants, and member autonomy.
• 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.
• Ensures timely resolution of elevated member issues or feedback.
• Assists with complex referrals needing special coordination and case management, consults with care coordinator or other clinicians as needed.
• Facilitates and fulfills dental case management between CareOregon and delegated dental plan partners as needed to meet member needs.
• Assists and completes cases assigned by the Dental Care Coordinator and Contracting Specialist such as:
  • Provides intensive cross disciplinary care coordination and dental case management for complex dental members.
  • Works with members, providers and customer services to resolve member related issues.
  • Assists with care coordination and case management support and clinical, navigational and operational dental content expertise to interdisciplinary CareOregon departments and teams. 
  • Supports operational implications of care coordination software upgrades across the organization (such as GSI).
• Contributes to continuous process improvement through participation in team huddles, training, departmental, team, and organizational meetings.
• Assists in proactive case finding, provide documentation and facilitation of care coordination in relation to a member’s oral health needs.
• Documents all encounters in an accurate and timely manner in accordance with HIPAA laws, as well as internal policies and procedures.

Specialty Provider Relations Assistance

• Assists the Dental Care Coordinator and Contracting Specialist with Specialty Provider Relations as assigned.  Work may vary and include tasks such as the following:
  • Supports and assists specialty provider recruitment, contracting and onboarding.
  • Trains and orients some specialty provider offices staff to OHP and CareOregon Dental policies and procedures, regulations, and in the use of CareOregon systems.
  • Performs site visits of new providers, in response to complaints or as part of a provider improvement plan.

Customer Service and Dental Team Support

• Supports oral health promotion and escalation from across the organization.
• Partners with Dental Care Coordinator and Contract Specialist on complex referrals or high-risk members as needed.
• Provides Dental Access and Referral Coordinator supplemental and back up support, only as assigned.
• Other duties as assigned to support the work of the dental team.

Essential Department and Organization Functions

• Propose and implement process improvements.
• Meet deadlines for completion of workload.
• Maintain agreed upon work schedule.
• Demonstrate cooperation and teamwork.
• Provide cross-training on specific job responsibilities.
• Meet identified business goals that contribute to departmental goals.
• Maintain strict confidentiality, observing all HIPAA rules.
• Demonstrate cooperation and teamwork both with internal and external stakeholders.
• Perform other duties and projects as assigned.

Knowledge, Skills and Abilities Required

• Knowledge of clinical dental care, dental procedures and clinical workflow, dental patient care in the clinic setting and dental patient care management and ability to discuss dental procedures and treatment plans and options with the patient
• Knowledge of dental terminology and dental coding
• Ability to provide dental triage for patients/members
• Understands the relationships and co-morbidity of oral health and systemic health
• Understands of the nature of member engagement and vulnerable, at-risk populations;
• Knowledge of the social determinants of health, the impacts of trauma on health, and the unique needs of low-income and marginalized communities
• Ability to be sympathetic to member, family, and caregiver needs and ability to work with people in various states of pain, trauma, and tragedy
• Knowledge of the Oregon Health Plan and Medicaid Dental benefits/ covered-non-covered dental services
• Understanding of dental provider networks and dental clinic operations
• Excellent organizational skills and ability to manage multiple tasks with emphasis on case and care management priorities
• Ability to effectively gather relevant health and social information directly from the member or other sources
• Ability to develop a concise, initial assessment to appropriately triage and prioritize daily workflow
• Willingness to seek support from clinical staff and/or supervisors in the event of complex situations
• Ability to work independently, take accountability, and use sound judgment
• Excellent written and verbal communication skills
• Ability to effectively solve unique problems as they arise or identify when to escalate issues to appropriate department/supervisor
• Ability to develop and maintain excellent professional working relationships with primary dental providers and dental specialists, health disciplines and across multiple internal departments
• Ability to support and comply with organizational policies, procedures and guidelines
• Familiarity with standard office technology including Microsoft office software or comfort and experience with learning similar systems
• Familiarity with health plan claims systems, EDIE/Premanage, electronic health record applications and other sources of clinical information or comfort and experience with learning new systems

Physical Skills and Abilities

Cognitive and Other Skills and Abilities Required

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

• Minimum 3 years’ experience in the dental industry required, including experience with clinical patient care and metrics, dental provider networks, dental coding, dental clinic operations, scheduling, referrals, and the insurance authorization process. 
• Minimum 3 years of experience working with vulnerable populations in a healthcare or dental setting, social service agency; experience should include working with consumers of Medicaid healthcare services and an understanding of the psychosocial and medical barriers encountered by this population. 
• Expanded Function Dental Assistant (EFDA) certification or dental assisting experience

Preferred:

• Database experience (e.g., MMIS, QNXT, EDIE/PreManage, SAS, EPIC, and/or other EMR/EDR systems)

Working Conditions

• Environment:  This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

? Inside/office            ? Clinics/health facilities         ? Member homes

? Other:                                                                                                         

• Travel:  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.
• Equipment:  General office equipment
• Hazards:  n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply. 

Equal opportunity employer.  This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.