What are the responsibilities and job description for the Health Management Care Transitions Supervisor (Hybrid Option) position at Partners Health Management?
Competitive Compensation & Benefits Package!
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 12 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
- Public Service Loan Forgiveness Qualifying Employer
Office Location: Available for any of Partners' NC locations.
Primary Purpose of Position: The Health Management Care Transitions Supervisor manages and supervises a Care Transition Care Management team. This position is responsible for management duties relating to Care Transition and ensures that members receive coordination and continuity of care as they transition between different settings or levels of care. This Includes but is not limited to; acute hospitals, EDs, skilled nursing homes, facility-based crisis, assisted living facilities and jail/prisons. This position will also assist members in their efforts to improve their quality of life across the Physical Health, Behavioral Health, Intellectual/developmental Disability (IDD), Traumatic Brain Injury (TBI), and Pharmacy domains to help prevent hospital readmission. The Health Management Care Transitions Supervisor works with the member, Tailored Care Manager, Utilization Management and care team to identify and alleviate inappropriate levels of care or gaps in services. Travel is an essential function of this position.
Role and Responsibilities:
- Supervises staff of assigned Health Management Care Transitions team which may include (Qualified Professionals, Registered Nurses, Licensed Clinical Social Workers, Licensed Clinical Mental Health Counselors, etc.)
- Completes weekly, monthly, quarterly, and other performance reporting as required or needed related to individuals categorized as “high cost” “high risk” or “special population”
- Provides communication and technical assistance with providers, members, stakeholders, and other LME/MCO staff regarding Health Management Care Transitions responsibilities and functions
- Creates problem-solving and goal-oriented partnerships with individuals/legally responsible persons, providers, etc.
- Provides training and instruction regarding Care Transition Team meeting facilitation for Care Transition members, treatment team planning and the Four Quadrant Care Management Model to staff, community, and stakeholders
- Provides ongoing training and instruction regarding Service Definition requirements, provider network capacity, and medical necessity criteria to staff, community, and stakeholders as needed
- Meets departmental goals to ensure that the following criteria are met for the Health Management Care Transitions Team:
o Timely development of the care plan, crisis plan and Behavior Support Plan (as applicable)
o Identification and use of natural/community resources through the assessment/planning process
o Appropriately updated assessments/plans
o Services are monitored (including direct observation of service delivery) in all settings
o Reporting of critical incidents
o Timely follow-up on any concerns/issues
o Timely submission of authorization requests for all LME/MCO funded services/supports
o All clinical documentation (e.g. goals, plans, progress notes, etc.) meet State, agency and Medicaid requirements
o Medical record compliance/quality, as demonstrated by ensuring 95% compliance on Qualitative Record Reviews
o Weekly data sharing with the CCNC Informatics center and documentation of minimum monthly meetings with CCNC to facilitate communication and develop integrated care practices
- Collaborates with CCNC, hospitals, and physicians within LME/MCO area to develop and implement plans, Management of activities, and management of deliverables for individuals categorized as “high cost” or “high risk” or “special population” due to frequent and intensive medical needs
- Provides clinical consultation
o Ensures continuity of care for intensive crisis services and other levels of care
o Performs prior authorization review, continued stay and discharge reviews for services
o Conducts chart reviews for care determinations to assist staff with creative problem solving to suggest alternative approaches to care
o Utilizes clinical knowledge on a range of diagnosis for children and adults
o Makes sound judgments based on clinical and legal requirements, client needs, and the crisis intervention and recovery model and community resources
Knowledge, Skills and Abilities:
- Comprehensive knowledge of assessment and treatment of MHSU needs, with or without co-occurring I/DD needs
- Considerable knowledge of the MH/SU/IDD service array provided through the network of the LME/MCO’s providers
- Working knowledge of laws, regulations, and program practices/requirements impacting members and families
- Exceptional leadership and interpersonal skills; highly effective communication ability
- Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
- Excellent problem solving, negotiation and conflict resolution skills
- Propensity to make prompt, independent decisions based upon relevant facts and established processes
- Detail oriented, able to independently organize multiple tasks and priorities, and to effectively complete reporting measures within assigned timeframes
Education/Experience Required:
- Licensure as a RN or Master’s-level fully Licensed Clinical Social Worker (LCSW), fully Licensed Clinical Mental Health Counselor (LCMHC), fully Licensed Clinical Addiction Specialist (LCAS), fully Licensed Psychological Associate (LPA), fully Licensed Marriage and Family Therapist (LMFT), and
- Three (3) years of experience providing care transition, care management, case management, or care coordination to the population being served of a supervising care manager.
- Must reside in North Carolina.
- Must have ability to travel as needed to perform the job duties
Education/Experience Preferred: Above Requirements
Licensure/Certification Requirements: Licensed Clinical Social Worker (LCSW), fully Licensed Clinical Mental Health Counselor (LCMHC), fully Licensed Clinical Addiction Specialist (LCAS), fully Licensed Psychological Associate (LPA), fully Licensed Marriage and Family Therapist (LMFT), or licensure as an RN Employee is responsible for complying with respective licensure board’s continuing education/training requirements in order to maintain an active license.
