Medicare Member Clinical Liaison

Position Title: Medicare Member Clinical Liaison
Department: Care Management
Title of Manager: Population Health Nurse Manager
Supervises: Non-supervisory position
Exemption Status: Exempt
Requisition ID: 20547

Job Summary
The Medicare Member Clinical Liaison works independently and cross-functionally with a team of clinical, customer service, and grievance professionals to provide members with opportunities to improve self-management abilities, health outcomes, and satisfaction with health care. This position performs a variety of key services such as intensive case management for both physical or behavioral care, short-term problem solving, referrals to community resources and specialty providers and health literacy education. Also, this position has specialized training in Evidence Based Practices providing behavioral changes, de-escalation techniques, as well as experience working with diverse populations that have experienced obstacles and barriers associated with marginalization either in mental health or physical health systems. With the knowledge of Trauma Informed Care and the skills of Motivational Interviewing, the Medicare Member Clinical Liaison is responsible for engaging with members whose level of dissatisfaction with their care requires compassionate and focused intervention. This position will focus on care within a Medicare dual-eligible special needs population.

Education and/or Experience
Required:
Master’s Degree in Counseling Psychology, Social Work, Marriage and Family Counseling, or related clinical field
Minimum 2 years’ experience in behavioral health, care management, and care coordination and/or social services
Minimum 2 years’ experience working with escalated cases in customer service or clinical setting
Preferred:
Experience working with Medicare Special Needs members, utilization of motivational interviewing and trauma informed care
Specialized training in Evidence Based Practices providing behavioral changes
Experience working with diverse populations that have experienced obstacles and barriers associated with marginalization either in mental health and/or addictions work

Essential Responsibilities
Point of Contact
Serve as the Liaison and point of contact to a panel of members with very high needs and frequent interactions with the health plan. Goals are to increase member satisfaction, reduce burden on other internal teams, and improve the overall health and quality of life for panel of members assigned.

Case Management
Work independently to perform multidisciplinary assessment of members by evaluating all relevant information to determine needs in health care, plan customer service, social supports and access to behavioral health services.
Utilize care management or customer service systems for documentation of member care plan, interactions, and needs.
Collaborate with clinical, customer service, and grievance teams to assist member in managing their care.
Complete appropriate documentation in a timely manner.

Barrier Review and Reduction
Work with members to identify and reduce or eliminate barriers to care (e.g., social, cultural, linguistic, education), and set effective goals with members.
Utilize a person-centered approach in working with clients by respecting their self-determination and autonomy and exploring their ambivalence by utilizing Motivational Interviewing principles.
Ensure that clients get timely access to appropriate services by promoting and modeling advocacy skills.

Provider and Member Integration
Collaborate with medical and auxiliary providers in the community to develop health care plans/goals based on identified needs and employ creative strategies to address psychosocial issues.
Facilitate communication and positive relationship building between clients and medical providers.

Work Management and Evaluation
Work autonomously in identifying tasks, developing plans, following through on needs, and evaluating outcomes to effectively set priorities and deadlines.
Report on progress and concerns as appropriate.

Improvement and Innovation
Propose, implement, and support process improvement and innovation in the workplace.
Identify and participate in the development of new alternative care resources not offered by the health plan and creatively utilize community resources.

Program Representation
Represent CareOregon Advantage to internal and external customers by maintaining the highest level of respect and professionalism.
Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision and values.
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.
Strive to meet annual business goals in support the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.

Knowledge, Skills and Abilities Required
Knowledge
Working knowledge and use of Trauma Informed language and principles
Knowledge of managed health care principles
Knowledge of impact of generational poverty, aging, disability, and other social determinants of health on clients’ ability to develop and follow self-care goals to improve health outcomes
Specific knowledge of working with special needs populations and people with co-occurring physical and behavioral health chronic conditions.
Skills
Strong word processing and computer skills and ability to learn new technological means of communication and various data bases
Strong skills in de-escalation techniques, negotiating with angry customers, and intensive case management
Excellent time management skills and attention to details to maintain focus and meet case load expectations are essential to this position
Excellent verbal and written communication and problem-solving skills

Abilities
Ability to exercise sound clinical judgment, independent analysis and critical thinking skills and knowledge of medical and behavioral health conditions when identifying clients’ multidisciplinary needs, developing health goals and communicating with providers
Ability to ensure and respect clients’ rights to self-determination and choices in health care
Ability to implement health promotion activities with clients by setting and reviewing health improvement goals
Ability to coordinate with health plans and providers to ensure consideration is given to unique clients’ needs in care planning
Ability to establish effective collaborative working relationships with state, county, and community agencies that provide services
Ability to follow and meet identified team, departmental, and organizational policies and procedures
Ability to participate in all staff development trainings and meetings
Ability to work with clients from various cultural and ethnic backgrounds demonstrating cultural knowledge and sensitivity to populations being served
Ability to work in an environment with diverse individuals and groups
Ability to adapt to fast paced environment and flexible in operating in different work settings by communicating with specialists from various educational backgrounds
Ability to work independently and collaborate with peers and supervisors

Physical Skills and Abilities Required
Lifting/Carrying up to 10 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
Crouching/Crawling
Reaching
Climbing Stairs
Repetitive Finger/Wrist/Elbow/
Shoulder/Neck Movement
0 hours/day
0 hours/day
0 hours/day
0 hours/day
0 hours/day
0 hours/day
More than 6 hours/day

Standing
Walking
Sitting
Bending
Seeing
Reading
Hearing
Speaking Clearly
0 hours/day
0 hours/day
0 hours/day
0 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day

Cognitive and Other Skills and Abilities
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.

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.

Position Description »