Umpqua Health

Care Coordinator

• Perform comprehensive member assessments, including face-to-face and in-home visits
• Develop and implement individualized care plans with members, caregivers, physicians, and support networks
• Monitor care plans, document interventions, and adjust plans as needed
• Promote integration of behavioral health, LTSS, and community resources
• Evaluate benefits and advise on funding sources
• Facilitate interdisciplinary care team meetings and collaborate with team members
• Use motivational interviewing to educate and support members
• Identify barriers to care and address psychosocial, financial, and medical concerns
• Develop prevention plans for critical incidents to protect member health and safety
• Maintain accurate documentation in electronic systems and comply with standards
• Manage a caseload of Medicaid and Medicare members, including LTSS waiver participants
• Travel locally 25–40% for member visits

Care Coordinator, Licensed

Solutions Engineer

• Lead the design, development, and implementation of software solutions supporting health plan operations
• Collaborate with cross-functional teams to gather requirements and deliver scalable, high-performance technical solutions
• Develop, maintain, and support full-stack web applications and application codebases
• Architect database schemas, data models, and backend services supporting applications, reporting, and member outcome calculations
• Develop, optimize, and maintain SQL queries, stored procedures, and C# applications integrated with .NET, SQL Server, and third-party systems
• Design and support JavaScript and TypeScript web solutions using Angular, AngularJS, and jQuery
• Translate technical and functional requirements into SQL and/or C# solutions and backend implementations
• Design, develop, maintain, optimize, and document business intelligence and data warehouse solutions
• Maintain, troubleshoot, and optimize Microsoft SQL Server databases
• Develop and support automation for data movement, reporting, validation, and system integrations
• Manage SQL Server Agent jobs, scheduling, backups, disaster recovery, and enterprise database operations
• Develop data flow diagrams, data models, and documentation for data governance and system transparency
• Build reporting tools, automated health checks, and validation processes
• Partner with IT and Network Security teams on system security, integrity, and performance
• Identify, troubleshoot, and resolve system defects, data discrepancies, and performance issues
• Analyze and validate data across systems for accurate and consistent reporting
• Evaluate and implement emerging technologies, tools, and frameworks
• Provide technical mentorship and guidance to development team members
• Maintain system availability, performance, and reliability across supported platforms

• Perform comprehensive member assessments, including face-to-face and in-home visits
• Develop and implement individualized care plans with members, caregivers, physicians, and support networks
• Monitor care plans, document interventions, and adjust plans as needed
• Promote integration of behavioral health, LTSS, and community resources
• Evaluate benefits and advise on funding sources
• Facilitate interdisciplinary care team meetings and collaborate with team members
• Use motivational interviewing to educate and support members
• Identify barriers to care and address psychosocial, financial, and medical concerns
• Develop prevention plans for critical incidents to protect member health and safety
• Maintain accurate documentation in electronic systems and comply with standards
• Travel locally 25–40% for member visits
• Perform other duties as assigned

Care Coordinator – Licensed

Nurse

• Perform clinical assessments and prior authorizations to determine medical necessity
• Escalate complex cases to Medical Directors and request additional documentation
• Collaborate with care coordinators, discharge planners, and interdisciplinary teams for care transitions
• Liaise with internal departments to resolve eligibility, benefits, or service issues
• Participate in discharge planning for members transitioning from acute, long-term, or residential care
• Conduct audits and support quality improvement initiatives
• Provide training and mentorship on utilization management protocols and workflows
• Maintain relationships with community providers and service organizations
• Ensure compliance with organizational policies, clinical standards, and federal/state regulations
• Perform other nursing-related duties as assigned

Utilization Review Nurse

Clinician

• Evaluate behavioral health and substance use disorder services for medical necessity, level of care, benefit eligibility, and compliance with clinical guidelines
• Review behavioral health, Health-Related Social Needs, and Flexible Services requests for appropriateness and coverage
• Conduct prospective, concurrent, and retrospective reviews, including inpatient behavioral health reviews, discharge planning, and transitions of care
• Apply clinical judgment and evidence-based criteria to make utilization decisions and identify cases requiring Medical Director review
• Request and evaluate additional clinical information from providers and members
• Complete appeal reviews with the Grievance and Appeals team
• Collaborate with care management teams, providers, and internal departments to support integrated behavioral and physical healthcare
• Advocate for members' access to timely, effective care in the least restrictive appropriate setting
• Support transitions from inpatient, residential, acute care, and Oregon State Hospital settings to community-based services
• Identify barriers to care and support solutions promoting continuity and improved outcomes
• Partner with providers and healthcare teams regarding treatment plans, level of care, and utilization management processes
• Educate providers, members, and families about behavioral health benefits, services, and resources
• Develop and maintain relationships with community providers and organizations
• Maintain compliance with Umpqua Health policies, contractual requirements, OAR, OHP, Medicare guidelines, and grievance and appeal requirements
• Maintain accurate, timely, comprehensive clinical documentation
• Conduct quality reviews and audits for process improvement
• Meet departmental productivity, accuracy, quality, and turnaround-time expectations
• Collaborate with Third-Party Recovery and Customer Care teams regarding coverage, eligibility, and coordination of benefits
• Participate in clinical rounds, case reviews, and interdisciplinary discussions
• Provide training and support to new employees and cross-functional teams
• Perform other assigned duties

Utilization Review Clinician

• Provides comprehensive support for care management and care coordination activities for members enrolled in Medicaid and Medicare programs
• Manages a caseload of members, conducts in-home assessments, and collaborates with a multidisciplinary team to ensure integrated, high-quality care across the continuum
• Performs comprehensive member assessments, including face-to-face and in-home visits as required
• Develops and implements individualized care plans in collaboration with members, caregivers, physicians, and support networks
• Monitors care plans for effectiveness, documents interventions, and adjusts as needed
• Promotes integration of services, including behavioral health, LTSS, and community resources
• Evaluates benefits and advises on funding sources
• Facilitates interdisciplinary care team (ICT) meetings and collaborates informally with team members
• Uses motivational interviewing techniques to educate and support members
• Identifies barriers to care and provides assistance to address psychosocial, financial, and medical concerns
• Develops prevention plans for critical incidents to ensure member health and safety
• Maintains accurate documentation in electronic systems and adheres to compliance standards
• Travels locally (25–40%) for member visits; mileage reimbursement provided.

• Provides comprehensive support for care management and care coordination activities for members enrolled in Medicaid and Medicare programs, including those receiving long-term services and support (LTSS) through waiver programs.
• Manages a caseload of members, conducts in-home assessments, and collaborates with a multidisciplinary team to ensure integrated, high-quality care across the continuum.
• Performs comprehensive member assessments, including face-to-face and in-home visits as required.
• Develops and implements individualized care plans in collaboration with members, caregivers, physicians, and support networks.
• Monitors care plans for effectiveness, documents interventions, and adjustments as needed.
• Promotes integration of services, including behavioral health, LTSS, and community resources.
• Evaluates benefits and advises on funding sources.
• Facilitates interdisciplinary care team (ICT) meetings and collaborates informally with team members.
• Uses motivational interviewing techniques to educate and support members.
• Identifies barriers to care and provides assistance to address psychosocial, financial, and medical concerns.
• Develops prevention plans for critical incidents to ensure member health and safety.
• Maintains accurate documentation in electronic systems and adheres to compliance standards.
• Travels locally (25–40%) for member visits; mileage reimbursement provided.