Tailored Care Manager

Advantage Behavioral Healthcare in Whiteville, NC is hiring a Tailored Care Manager to provide the primary care management model for BH I/DD Tailored Plans, and operates on the key principle that physical health, behavioral health, and I/DD-related needs are integrated through the care team. Tailored Care Management will provide qualified members with a single care manager who will be equipped to manage all of a members’ needs, spanning physical health, behavioral health, I/DD, TBI, pharmacy, LTSS, and unmet health-related resource needs.

Responsibilities:

• Share relevant information with members, their families, and caregivers in a manner that respects language, literacy, cultural preferences, and accessibility needs (e.g., sign language, closed captioning). Foster open communication within the team and with administration, ensuring transparency and mutual exchange of ideas and information. Communicate and document member needs, care plans, and team interactions while maintaining privacy and confidentiality.
• Oversee the development, monitoring, and review of care plans, assessments, and individual service plans (ISPs) to ensure they are person-centered and meet required timelines. Ensure timely documentation in electronic health records (EHR), including assessments, care plans, referrals, and member data. Monitor and support the delivery of integrated care across various service sectors (healthcare, social services, etc.) for members with complex needs, including transitions from clinical settings.
• Ensure staff possess required competencies, including service delivery, clinical skills, health promotion, customer service, and data management. Provide oversight to care managers, ensuring comprehensive assessments are completed accurately and timely, and provide supervision and support as needed.
• Manage care transitions for members moving between clinical settings, ensuring smooth handoffs, medication reconciliation, and post-discharge support. Assist care managers with transitions for special populations to community-based settings, ensuring appropriate resources and supports.
• Assist members with accessing community-based resources, supported housing, and services for independent living. Develop and maintain plans that reflect informed choices, supporting members’ desire to remain in the community.
• Utilize EHR and care management systems to document, store, and share member information in compliance with privacy, security, and data-sharing regulations. Regularly review data for accuracy and ensure timely updates to care plans and assessments.
• Provide clinical supervision and escalation guidance for the care team, offering support for challenging cases and collaborating with consultants when necessary. Respond to high-risk alerts and engage with community-based organizations to improve care coordination.
• Provide education to members and their caregivers regarding treatment plans, transitions, and resource options. Ensure members are linked to appropriate services and supports, and monitor for trigger events that require immediate intervention.
• Maintain accurate records, participate in peer reviews, and attend required training. Ensure compliance with organizational standards, including timely documentation, billing, and reporting. Provide supervision and performance evaluations for assigned staff.

Requirements:

• Meet North Carolina’s definition of a Qualified Professional per 10A-NCAC 27G .0104; and
• For care managers serving members with LTSS needs: two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience. (This experience may be concurrent with the years of experience required to become a Qualified Professional.).
• A bachelor’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area and two years of experience providing care management, case management, or care coordination to complex individuals with I/DD or TBI; or
• A master’s degree in a field related to health, psychology, sociology, social work (e.g., LCSW), nursing, or another relevant human services area, or licensure as an RN and one years of experience providing care management, case management, or care coordination to complex individuals with an I/DD or a TBI