I/DD Care Manager - QP (Gaston/Cleveland/Rutheford)

LOCATION: Remote – must live in or near Gaston, Cleveland, or Rutherford County, North Carolina. The person in this position is required to maintain residency in North Carolina or within 40 miles of the NC border. This position requires travel.

GENERAL STATEMENT OF JOB 

The Intellectual and Developmental Disabilities (I/DD) Care Manager is responsible for providing Tailored Care Management and/or care coordination to members/recipients with I/DD to help secure and coordinate a variety of physical health, developmental disability, behavioral health and long-term services and support (LTSS) services. The I/DD Care Manager actively engages with members/recipients through comprehensive assessment, care planning, health promotion, and comprehensive transitional care. Tailored Care Management is comprehensive and longitudinal for members with Medicaid coverage. Recipients with no Medicaid receive Tailored Care Management based on specified triggers and for a duration not to exceed ninety (90) days. Travel is an essential function of this position.

ESSENTIAL JOB FUNCTIONS

Duties of the I/DD Care Manager include, but are not limited to, the following: 

Comprehensive Care Management

• Provide assessment and care management services aimed at the integration of primary, behavioral and specialty health care and community support services, using a comprehensive person-centered care plan which addresses all clinical and non-clinical needs and promotes wellness and management of chronic conditions in pursuit of optimal health outcomes
• Complete a care management comprehensive assessment (CMCA) / Health Risk Assessment (HRA) within required timelines and update as needed or as required given triggering events
• Develop a comprehensive Care Plan/Individual Support Plan (CP/ISP) and update as needed
• Provide diversion activities to support community tenure 

Care Coordination

• Facilitate access to and the monitoring of services identified in the Care Plan / Individual Support Plan to manage chronic conditions for optimal health outcomes and to promote wellness. 
• Facilitate communication and regularly scheduled interdisciplinary team meetings to review care plans and assess progress.
• Monitors services for compliance with state standards and Medicaid regulations, including home and community-based standards for 1915(i) services
• Verify that services are delivered as outlined in the CP/ISP and addresses any deviations in services

Individual and Family Supports

• Provide education and guidance on self-management and self-advocacy 
• Provide information about rights, protections, and responsibilities, including the right to change providers, the grievance and complaint resolution process, and fair hearing processes
• Educate members and recipients about the Registry of Unmet Needs / Innovations and TBI Waitlists, with referral as indicated
• Utilize person centered planning methods/strategies to gather information and to get to know the members supported
• Ensure that members/legally responsible persons are informed of services available, service options available, processes (e.g. requirements for specific service), etc. 
• Promote prevention and health through education on the member’s chronic conditions and/or disabilities for the member, family members, and their caregivers/support members
• Promote culturally competent services and supports. 

Health Promotion

• Educate and engage the member/recipient and caregivers in making decisions that promote his/her maximum independent living skills, good health, pro-active management of chronic conditions, early identification of risk factors, and appropriate screening for emerging health problems
• Closely coordinate care with the member’s I/DD, behavioral health, and physical health providers, including in person visits to Emergency Departments and Skilled Nursing Facilities 
• Support medication management as prescribed by medical providers, focusing on treatment adherence monitoring, side effects, and effectiveness of treatment

Transitional Care Management 

• Proactive and intentional care management when the member/recipient is experiencing care transitions (including, but not limited to, transitions related to hospitalization, nursing facility, rehabilitation facility, community-based group home, etc.), significant life changes including, but not limited to, loss of primary caregiver, transition from school services, etc.) or when a member/recipient is transitioning between health plans. 
• Create and implement a 90-day transition plan as an amendment to the CP/ISP that outlines how services will be maintained or accessed and includes a process to transition to the new care setting and integrate into his or her community. 

Referral to Community/Social Supports

• Provide information and assistance in referring members/recipients to community-based resources and social support services, regardless of funding source, which can meet identified needs
• Provide comprehensive assistance securing health-related services, including assistance with initial application and renewal with filling out and submitting applications and gathering and submitting required documentation, including in-person assistance when it is the most efficient and effective approach. 

Time-Limited Care Coordination for Member Excluded from Receiving Tailored Care Management

• Assist members who are receiving care management from other entities (e.g., CCNC, CAP/C, CAP/DA) with referral/linkage to I/DD services available through the Tailored Plan or Medicaid Direct contract
• Provide transitional care management 
• Participate in weekly conference with CCNC, as needed, to share information on high-risk members, including members with a behavioral health transitional care need and members with special health care needs, who are receiving care coordination and care management from both entities or require referrals
• Coordinate with each member’s care manager to the extent the member is engaged in care management through another entity (e.g. PCCM Vendor, Skilled Nursing Facility, CAP/C or CAP/DA, etc.) 
• Share the results of any assessments completed, the member’s person-centered plan, and the member’s Care Plan (to the extent one exists) with entity providing care management
• Notify the member’s care manager that the member is undergoing a transition and engage the member’s assigned care manager to assist with transitioning the member into the community, including in the development of the ninety (90) day post-discharge transition plan to the extent there are items within the care manager’s scope. 
• With the assistance of the care management entity, encouraging, supporting, and facilitating communication between primary care providers and the Vaya Partners network providers regarding medication management, shared roles in care transitions and ongoing care, the exchange of clinically relevant information, annual exams, coordination of services, case consultation, and problem-solving as well as identification of a medical home for persons determined to have need. 

Other:

• Assist state-funded recipients apply for Medicaid 
• Coordinate Medicaid deductibles, as applicable, with the member/legally responsible person and provider(s)
• Proactively monitor documentation/billing to ensure that issues/errors are resolved as quickly as possible
• Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency and Medicaid requirements
• Maintain medical record compliance/quality, as demonstrated by ≥90% compliance on Qualitative Record Reviews 
• Recognizes and reports critical incidents
• Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues
• Collaborates with providers to ensure accurate/timely submission of authorization requests for all Tailor Plan-funded services/supports
• Document within the grievance system any expression of dissatisfaction/concern expressed by member/recipient supported or others on behalf of the member/recipient supported
• Ensure strong leadership to care team for each member/recipient, including effectively communicating with and providing direction to Care Management extenders

KNOWLEDGE, SKILLS, & ABILITIES

• Demonstrated knowledge of the assessment and treatment of I/DD needs, with or without co-occurring physical health, mental health or substance use disorder needs
  
• Ability to develop strong, person-centered plans 
• Exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes
• Demonstrated ability to collaborate and communicate effectively in team environment
• Ability to maintain effective and professional relationships with members/recipients, family members and other members of the care team
• Problem solving, negotiation and conflict resolution skills 
• Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
• Detail oriented
• Ability to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiries
• Ability to independently organize multiple tasks and priorities and to effectively complete duties within assigned timeframes
• Ability to manage and uphold integrity and confidentiality of sensitive data
• Sensitivity and knowledge of different cultures, ethnicities, spiritual beliefs and sexual orientation.

EDUCATION & EXPERIENCE REQUIREMENTS

• Bachelor’s degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area and two (2) years of full-time experience with I/DD population OR 
• Bachelor’s degree in a field other than human services and four (4) years of full-time experience with I/DD population OR
• Master’s degree in human services and one (1) year of full-time experience with I/DD population OR
• Licensure as a registered nurse (RN) and four (4) years of full-time accumulated experience with I/DD 

AND

• Two (2) years of prior Long-Term Services and Supports (LTSS) and/or Home and Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working with I/DD population described above

AND

• Must reside in North Carolina (or within 40 miles of the border of North Carolina)
• Must have ability to travel regularly as needed to perform job duties

Education/Experience Preferred: 

Experience working with members/recipients with co-occurring physical health and/or behavioral health needs preferred.

Licensure/Certification Required:

If a Registered Nurse (RN), must be licensed in North Carolina.

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. 
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. 
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. 
• Mental concentration is required in all aspects of work. 
• Ability to drive and sit for extended periods of time (including in rural areas)

RESIDENCY REQUIREMENT: The person in this position is required to maintain residency in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation. 

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Partners accepts online applications in our Career Center, please visit Current Openings | Recruitment.

 Vaya Partners is an equal opportunity employer.