Job Title: Care Manager

Status: Full Time

Classification: Exempt

Management: No

Department: Tailored Care Management

Reports To: Director of Care Management

GENERAL DESCRIPTION:

Through Tailored Care Management, Behavioral Health Tailored Plan beneficiaries will have a designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all their needs, spanning physical health, behavioral health, pharmacy, and unmet health related resource needs. 

WORK DUTIES AND TASKS:

Complete comprehensive assessments at enrollment, yearly or at changes in condition. 

Develop Plans of Care derived from the completed assessments. 

Assign, evaluate, monitor, and oversee interventions, engagement activities, documentation, and plans of care that are designated for Care Management staff. 

Address, in the Plan of Care, if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. 

Assist individuals/legally responsible persons (LRP) in choosing service providers, ensuring objectivity in the process. 

Utilize Admission, Discharge, Transition information to respond within hours/minutes as appropriate to support members who are admitted, transferred, or discharged from a facility in a timely manner. 

Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification.? 

Utilize person centered planning, motivational interviewing, and historical review of assessments to gather information and to identify supports needed for the individual. 

Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual's needs and desired life goals 

Submit required documentation to the payor to ensure timely delivery of services - and trouble shoots until authorization is obtained. Notifies care team as appropriate of successful authorization. 

Schedule initial contact with member to verify accuracy of demographic information and thereafter update inaccurate information. 

Complete activities related to Plans of Care.? 

For facility (ICF, Hospital, PRTF or SDC) discharges, schedule an updated assessment to make sure needs are met. 

Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan. 

Schedule and facilitate the Care Plan meeting. 

Develop and update Care Plan 

Coordinate with other team members to ensure smooth transition to appropriate level of care.? 

Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.? 

Update other Care Team members of urgent or pertinent treatment updates? 

Recognize and report critical incidents to supervisors.? 

Schedule face to face meeting with member/LRP to provide education about care teams, services, needed supports, etc.? 

Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance. 

Escalate complex cases and cases of concern to Supervisor. 

Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues. 

Verify ongoing service adherence with member and/or guardian. 

Document all applicable member updates and activities per organizational procedure. 

Ensure that service orders/doctor's orders are obtained, as applicable. 

Obtain releases/documentation and provide to all stakeholders involved.? 

Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information 

Ensure clinical documentation (e.g., goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements as well as is entered in accordance to the agency policy.

Participate and complete all required agency trainings and meetings, as well as all required care management-based trainings from the State, Technical Assistance entity or payor and within required timeframes as assigned. 

Travel to various community locations, other agencies, and other outreach destinations as necessary to meet the members' needs. 

Maintain all certification(s) or licensure required for the position. 

Demonstrate awareness and knowledge of and comply with all agency policies and procedures, as well as state and federal statutes and regulations related to care management. 

Meet at least minimum standards of monthly contacts and demonstrate ability to effectively engage with members. 

Care manager will coordinate the member's health care and social services including behavioral health and pharmacy services as well as other SDOH needs. 

Participate in agency's twenty-four (24) hour coverage around care management providing for coverage for services, consultation or referral as needed and arrange treatment for emergency medical conditions including behavioral health crises. Specifically, coverage will include the ability to share information such as care plans and psychiatric advance directives and coordinate care to place the member in appropriate setting during urgent and emergent events.

Complete all other relevant responsibilities as assigned by supervisor. 

QUALIFICATIONS, EDUCATION AND EXPERIENCE REQUIREMENTS: 

A Bachelor's degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area, or licensure as a registered nurse (RN) and two years of experience working directly with individuals with behavioral health conditions (if serving members with behavioral health needs).

Must meet Qualified Professional (QP) requirements outlined in 10A NCAC 27G.0104 Staff Definitions.

No criminal convictions of child abuse or violent crimes.

Must be able to pass a criminal background, MVR, and Healthcare Registry Check

Must possess a valid driver's license.

Must be able to keep strict confidentiality and work with diverse populations.

In addition to competitive salaries and opportunities for advancement, full-time employees are offered a wide range of benefits to meet their individual needs, which includes:

Medical, Vision, Dental Insurance.

Life Insurance (Paid by Company).

PTO (Paid Time Off).

Paid Holidays.

Longevity Pay.

401K Retirement Plan.

Funeral Leave.

FMLA.

Supplemental Insurance offering through Aflac with Payroll Deduction.

Direct Deposit.

Training Opportunities.

Continuing Education Leave for Licensed Professionals (opportunity to gain free CEU's).

Free Clinical Supervision in Greenville (LCSWA/LCASA/CSAC).