Utilization Case Manager Jobs in Silverton, OR (NOW HIRING)

The Care Coordinator is responsible for telephone outreach to designated member populations to ensure retention, utilization of services, and satisfaction as well as meeting compliance regulations with reporting on these topics. Must reside in Oregon.

Assist with care coordination of members with special health care needs as designated by Coordinated Care Organizations (CCOs), the Oregon Health Authority (OHA), members, members' caregiver or their representative. This includes, but is not limited to:

• Contacting and counseling members in regards to emergency department usage for dental related reasons as reported through company's secure connect to the Emergency Department Information Exchange (EDIE) or directly from hospitals and CCOs
• Contacting and counseling members in regards to missing dental appointments as reported by primary care dental offices (PCDs)
• Assisting in the reassignment of dismissed of members from their current PCD and coordinating success care in the future for the member; escalating to a Care Coordinator, Advanced when necessary
• Coordinating care for members needing additional services in a dental practice after being seen in a community setting
• Community Partner Requests for assistance through Health Risk Screening
• Processing medical to dental referrals to care
• Processing of Pilot projects referrals to care

• Ensure all documentation is entered accurately and timely into all case management systems for continuity of care purposes
• Assist in improving the region's health by considering each community member's unique health, cultural and social needs
• Other duties as needed or required

Required:

• High school diploma or equivalent
• 6+ months of experience working with Medicaid populations by phone or in person, or equivalent
• Computer proficiency in a variety of Windows applications
• Attends additional training as requested/deemed necessary

Preferred:

• Certification as a Community Health Worker or other Traditional Health Worker designation
• 2+ years of experience working in a call center environment.
• Experience in a dental/medical insurance setting.

Physical Demands:

• Incumbent must be able to communicate effectively.
• Requires overall light physical effort (up to 25lbs.)
• Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal compute).
• Ability to travel or move about within and outside serviced facilities required.
• Incumbent works primarily in either a private or shared office environment.

Salary Range: $40,600 - $54,800

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work® Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.