Care Manager

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.

CORE COMPETENCIES: 

To perform effectively in this position, the individual should demonstrate the following competencies. These core competencies represent effective administration of Integrated Family Services, PLLC and its programs fulfilling the IFS mission.

Management: Maintains effective systems of internal controls to account for all billing for IFS clients assigned to the caseload.  Demonstrates the core values of IFS in maintaining effective administrative operations.

Job Knowledge: Understands the duties and responsibilities of the position and keeps job knowledge up to date. Clearly understands the mission of the organization and continuously works to promote IFS and achieve its goals.

Initiative in fulfilling the goals of the organization: From interactions with staff, the employee recognizes and brings to the attention of the department Director issues that affect the organization and implements plans to reach organizational goals as determined by the management team. Displays initiative in developing action plans and resolving problems as they occur, in consultation with the departmental supervisors and the department Director.

Communication: Maintains effective two-way communication with staff, community agencies, and other audiences using a variety of formats. Examples include: written communications that clearly outline the situation and action items; verbal presentations and briefings to the department Director and members of the management team.

Dependability: Seeks increased responsibility while remaining conscientious, thorough, accurate, and reliable with respect to achieving the organization's goals, and the needs of the IFS consumers and fellow staff. This includes being available and responsive to issues and concerns as they arise

PHYSICAL DEMANDS, WORK ENVIRONMENT, TRAVEL AND MISCELLANEOUS:

Physical Demands

While performing the duties of this job, the employee is regularly required to sit, stand, walk, speak and hear.  The position requires extensive computer use so the employee must have sufficient hand dexterity to use a computer keyboard and be capable of reading a computer screen.  The employee must rarely lift and/or move up to 20 pounds.  Reasonable accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions.

Work Environment

The work environment may be a small office or vary in areas conducive to the position requirements.  The noise level in the work environment is usually low to moderate.  Reasonable accommodations in the work environment may be made to enable individuals with disabilities to perform the essential functions.

Travel

The employee must be able to travel to perform the position requirements, to attend conferences, training and other events as required for acquiring and maintaining proficiency in fulfilling the responsibilities of the position.

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This job description is not intended to be all-inclusive. Employees may perform other related duties as determined to meet the on-going needs of the organization. Acknowledgement of this document is in receipt of this job description and does not create a contract of, or specify terms, conditions or a specific period of employment.

All employment relationships with Integrated Family Services, PLLC, are at-will and may be terminated at any time, with or without cause, with or without notice by either the employee or employer.

I acknowledge that I have received a copy of this job description, and it has been reviewed with me, and I understand the duties and requirements of the job.  I also acknowledge and understand that if I have any questions pertaining to the duties and requirements of my job that I may ask my immediate supervisor, departmental management or Human Resources.

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).