Location : Hybrid. Most of the positions at YCCO are hybrid, meaning they have the flexibility to work both remotely and/or in-person at YCCO's office in McMinnville, OR.

Department: Health Plan Operations FLSA Status: Exempt

Reports To: Nursing Director - RN Physical Strength: Light (L)

About Us: Yamhill Community Care is a nonprofit coordinated care organization dedicated to managing the healthcare for Medicaid members, covered under the Oregon Health Plan, in Yamhill County, as well as parts of Washington and Polk Counties. Our mission is to improve the quality of life of the communities we serve by coordinating effective care. Beyond healthcare, we also provide an Early Learning Hub, supporting families and children with essential resources and programs for early childhood development. Together, we're building a unified healthy community that celebrates physical, mental, emotional, spiritual, and social well-being.

Learn more about Yamhill Community Care:click here

Summary

The Social Needs Specialist is responsible for supporting the whole-person health care system within Yamhill Community Care (YCCO). This position will work collaboratively within the Utilization Management (UM) / Care Management (CM) Collaborative team to monitor and support functions related to Health-Related Services (HRS) Flex funds, Health-Related Social Needs (HRSN) and activities related to Social Determinants of Health (SDOH). It includes functioning as a point of contact for internal partners related to these areas of focus.

Essential Duties

1. Provides oversight and coordinate the HRS / HRSN Review Panel functions for review of cases requiring clinical review; facilitating case review by gathering necessary case information; processing review decisions; ensuring approval determinations are documented, coordinating with YCCO Finance department to ensure procurement of approved HRS Flex items is completed.
2. Facilitates tracking of health-related requests, approvals and purchases, working with Finance and other departments to reconcile monthly reports.
3. Serves as a subject matter expert on HRS requests and criteria, offering consultation to staff on submissions and limitations.

Job Duties

Health Related Services Flex, Health Related Social Needs & Social Determinants of Health

• Facilitates and provides oversight of the HRS Flex / HRSN Review Panel ensuring timely response to member HRS Flex / HRSN and other social needs.
• Gathers information from YCCO members, providers and community benefit organizations and members of the UM / CM Collaborative team to organize case presentations for the Panel review.
• Communicates Review Panel decisions to the requesting entity, members and internal YCCO staff as indicated through various avenues of communication.
• Ensures and facilitates complete and accurate documentation within the Helios platform on all HRS Flex and/or HRSN Panel review decisions.
• Coordinates with the Finance department to ensure HRS Flex approved items are promptly procured and items are tracked for monthly reconciliation.
• Develops content expertise and technical assistance to YCCO’s partners and community resources related to HRS Flex and HRSN services.
• Facilitates understanding in the use of UniteUS to YCCO staff, provider and community partners in accessing community resources in response to Social Determinant of health screenings.

General Social Needs Program Operations

• Assists with the design and development of processes to ensure compliance with HRS Flex and HRSN contract and regulatory requirements.
• Participates as needed in YCCO multi-disciplinary team meetings with staff and partners.
• Maintains and shares information according to privacy regulations.
• Develops and promotes person-centered services by educating self and others of YCCO programs, services, and other resources available.
• Prepares reports and performs special projects as assigned.
• Actively follows health plan best practices and professional code of conduct / ethics.
• Develops trust/credibility and effective communications within YCCO and external partners and providers.
• Assists team members and offers 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

• Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members.
• Self-directed ability to function with minimal oversight from supervisor daily.
• Works closely with other YCCO departments, including Finance, to assist in the reporting of the HRS Flex Exhibit L, and in the procurement of HRS Flex funded purchases.
• 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.
• Maintains agreed upon work schedule with punctual, regular, and predictable attendance.
• Attends in person Annual Company Conference in McMinnville, OR; typically held in the fourth week of September.
• Demonstrates cooperation and teamwork using a professional and respectful demeanor.
• Provides cross-training on specific job responsibilities.
• Meets identified goals that contribute to departmental goals.
• Works collaboratively in a team and matrixed (cross-department) environment with a spirit of cooperation.
• Respectfully takes direction from Supervisor.
• Performs other duties as assigned.
• 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.
• Ability to problem solve, analyze, and provide written documentation of analysis.
• Ability to build productive working relationships, problem solve and resolve conflicts successfully.
• Ability to function as an influential communicator and creative problem solver.
• Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with coworkers and others.
• Knowledge of rules regarding HRS Flex Services.
• Excellent organizational skills including ability to handle multiple priorities and demands simultaneously in a dynamic work environment while maintaining high attention to detail and accuracy.
• Ability to work independently, use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
• Excellent computer skills, including Microsoft Windows, Word, Excel, and Outlook.
• Ability to communicate both professionally and effectively in all forms of communication.
• Ability to work in an environment with diverse individuals and groups.
• Ability to remain flexible, positive, and adaptable.
• Ability to work across the YCCO region and to work remotely, as needed.

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 the safety or health of employees 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 accommodation may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

Required:

• Minimum two (2) years of related clinical and/or health plan experience.
• Bachelor’s degree in a health-related or social service area, which could include nursing, community-health, social work, public health, or another related field or comparable work experience.

OR:

• Any combination of education and experience that would qualify the candidate for the position.

Preferred:

• Master’s degree in health care administration, social work, community health or related healthcare field
• Experience in community health direct service
• Knowledge of managed care, Oregon Health Plan (OHP) benefits, Oregon Administrative Rules (OAR), Oregon Statute (ORS) or Community Care Organization (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 accommodation 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.