Innovations Care Manager (Remote Option-Cabarrus/Union)
Company: Partners Behavioral Health Management
Location: Kannapolis
Posted on: May 26, 2023
Job Description:
Competitive Compensation & Benefits Package!
Position eligible for -
- 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 See attachment for additional details.
Office Location: Cabarrus and Union Counties (Remote Option)
Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled
Primary Purpose of Position:
The Innovations Care Manager is responsible for providing Tailored
Care Management for members with intellectual/developmental
disabilities enrolled in the NC Innovations waiver. The Innovations
Care Manager is responsible for addressing members' whole-person
needs alongside coordinating and monitoring their waiver services.
The Innovations Care Manager actively engages with members through
comprehensive assessment, care planning, health promotion, and
comprehensive transitional care. If members enrolled in the waiver
opt out of Tailored Care Management, the member will remain
enrolled in the waiver and the Care Manager will provide Care
Coordination to monitor and coordinate waiver services. Travel is
an essential function of this position.
Role and Responsibilities:
Duties of the Innovations 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 within
required timelines and update as needed
- Develop a comprehensive Individual Support Plan and update as
needed
- Ensure that the member/legally responsible person (LRP) and all
others responsible for plan implementation sign the plan and
updates
- Educate members/LRP on methodology for budget development,
total dollar value of the budget and mechanisms available to modify
the member budget.
- Educate the member/LRP on waiver requirements/limits, however,
ensures services, as requested are outlined in the budget.
- Secure service authorizations for all Innovations waiver
services
- Ensures that service orders/doctor's orders are obtained, as
applicable
- Provide diversion activities to support community tenure
- Monitor services based on Innovations Waiver, Home and
Community Based Standards and Tailored Plan requirements Care
Coordination
- Facilitate access to and the monitoring of services identified
in the 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.
- Make announced/unannounced monitoring visits, including
nights/weekends as applicable
- Monitor services for compliance with state standards, waiver
requirements, and Medicaid regulations, as applicable
- Monitor to ensure that any restrictive interventions (including
protective devices used for behavioral support) are written into
the ISP and the Positive Behavior Support Plan
- Verify that services are delivered as outlined in person
centered plan and addresses any deviations in services
- Notify Utilization Management of any suspected or actual
changes in level of care
- Monitor compliance with home and community-based standards
Individual and Family Supports
- Provide education and guidance on self-management and
self-advocacy
- Provide information to the member about the member's rights,
protections, and responsibilities, including the right to change
providers, the grievance and complaint resolution process, and fair
hearing processes
- Help members make informed choices of care team participants,
provide information about providers, and arrange provider
interviews as needed Health Promotion
- Educate and engage the member and member's 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 Transitional Care Management
- Facilitation of services for the member and family/caregiver
when the member 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 is transitioning between health plans.
- Create and implement a 90-day transition plan as an amendment
to the member's ISP that outlines how the member will maintain or
access needed services and supports, transition to the new care
setting, and integrate into his or her community.
- Proactively responds to a member's planned movement outside the
LME/MCO geographic area to ensure changes in their Medicaid County
of eligibility are addressed prior to any loss of service Referral
to Community/Social Supports
- Provide information and assistance in referring members 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 Other:
- Verify member's continuing eligibility for Medicaid with
Indicators and promptly follows-up on identified issues, as
indicated
- Coordinate Medicaid deductibles, as applicable, with the
member/legally responsible person and provider(s)
- Proactively monitor own 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
- Document within the grievance system any expression of
dissatisfaction/concern expressed by members supported or others on
behalf of the member supported
- Ensure strong leadership to care team, including effectively
communicating with and providing direction to Care Management
extenders Knowledge, Skills and 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 written and
oral communication skills, 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, 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 and Experience
Required:
- 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 NC
border
- Must have ability to travel regularly as needed to perform job
duties
Education/Experience Preferred:
Experience working with members with co-occurring physical health
and/or behavioral health needs preferred.
Licensure/Certification Requirements:
If a Registered Nurse (RN), must be licensed in North
Carolina.
Keywords: Partners Behavioral Health Management, Kannapolis , Innovations Care Manager (Remote Option-Cabarrus/Union), Executive , Kannapolis, North Carolina
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