Care Manager - LP (Jackson County, NC)
Vaya Health, Raleigh, NC, United States
LOCATION
Remote - must live in or near Jackson 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 Care Manager Licensed Professional ("Care Manager - LP") is responsible for providing proactive intervention and coordination of care to eligible members to ensure they receive appropriate assessment and services. The Care Manager - LP works with the member and care team to identify and alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services across MH, SU, I/DD, TBI, physical health, pharmacy, LTSS, and unmet health-related resource needs. The Care Manager - LP supports and may provide clinical transition planning assistance to state and community hospitals and residential facilities, and tracks individuals discharged from facility settings to ensure follow-up and necessary aftercare services. This is a mobile position with work done in a variety of locations, including members\' home communities. The Care Manager - LP also works with other staff, members, relatives, caregivers, providers, and community stakeholders. The Care Manager - LP utilizes licensed clinical knowledge and skills to assess needs, inform care planning development, provide clinical consultation, and offer recommendations for appropriate care.
As described, essential job functions include, but are not limited to:
Utilization of and proficiency with Vaya\'s Care Management software platform/ administrative health record (AHR)
Outreach and engagement
Compliance with HIPAA requirements, including Authorization for Release of Information (ROI) practices
Performing Health Risk Assessments (HRA): comprehensive bio-psycho-social assessments addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care
Adherence to Medication List and Continuity of Care processes
Participation in interdisciplinary care team meetings and ongoing care management
Transitional Care Management
Diversion from institutional placement
This position is required to meet NC Residency requirements defined by the NC Department of Health and Human Services. The role requires living in or near the counties served to deliver in-person contacts with members and their care teams.
ESSENTIAL JOB FUNCTIONS
Clinical Assessment, Care Planning, and Interdisciplinary Care Team:
Ensures identification, assessment, and person-centered care planning for members.
Links members with necessary formal/informal services across medical and behavioral health areas.
Meets with members to conduct the HRA and gather information on health, behavioral health, medical, and social needs.
Administers screenings (PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and others) and provides education and self-management strategies and linkage to supports.
Assists with medication reconciliation and creates a multisource medication list shared with prescribers.
Supports the care team in developing a person-centered Care Plan addressing mental health, substance use, medical, and social needs and personal goals; ensures elements required by NCDHHS.
Engages with the care team to ensure appropriate assessment and integration of information; resolves barriers and dissatisfaction with services.
Uses clinical skills to review provider assessments for clinical accuracy and may provide consultation to providers as needed.
Interprets and analyzes assessments to support care management activities; engages with provider staff on clinical appropriateness and course of action for complex needs.
Helps members refine treatment goals, identify interventions, and monitor progress.
Informs member/LRP about available services and referral processes; supports choice of providers and objectivity in the process.
Works with members and the care team to address needs and ensure member/LRP involvement; facilitates care team meetings when needed.
Solicits input from the care team and monitors progress; ensures assessment and care plan information is shared with the care team.
Reviews assessments and provides clinical input to ensure needs are addressed; provides crisis plan development and care management in crisis situations as needed.
Updates Care Plans and Care Management assessments at least annually or with significant life changes; supports prevention and population health management education and referrals.
Supports development of a Crisis Plan tailored to member needs and coordinates crisis intervention when necessary in the community.
Supports Transitional Care Management and Diversion efforts for members at risk of institutional care; coordinates with leadership as needed.
Consults with care management leadership and other colleagues to support effective member care.
Collaboration, Coordination, Documentation:
Uses advanced knowledge and licensure to participate in independent decisions affecting clinical outcomes.
Drives initiatives promoting integrated, whole-person care; identifies system barriers with community stakeholders.
Manages and facilitates high-risk team meetings with community partners as appropriate.
Partners with other Vaya departments to address gaps in services and access to care within the catchment area.
Participates in cross-functional meetings and projects; engages in routine multidisciplinary huddles to present complex cases and support CM interventions.
Monitors service provision for quality and compliance with standards; escalates health and safety concerns as needed.
Maintains member satisfaction through ongoing communication and timely follow-up; educates members/families on services and resources.
Verifies Medicaid eligibility and coordinates movement outside the catchment to prevent loss of service.
Ensures documentation in the AHR is complete and accurate; maintains compliance and quality per policy and contracts.
Participates in required trainings and committees as requested.
Other duties as assigned.
KNOWLEDGE, SKILLS, & ABILITIES
Clear and concise communication; effective interpersonal skills.
Ability to drive and sit for extended periods (including in rural areas).
Professional representation of Vaya and relationship-building abilities.
Strong attention to detail and organizational skills.
Independent decision-making with relevant facts.
Problem solving, negotiation, arbitration, and conflict resolution with diplomacy.
Results-oriented with urgency in issue resolution.
Adaptability to multiple demands, shifting priorities, ambiguity, and change.
Proficiency in Microsoft Office and Vaya systems, including care management platform and data analysis.
Ability to shift between macro and micro planning; understand big picture and details.
Utilizes clinical training and licensure to perform assessments and support care management and providers.
Extensive understanding of DSM and MH/SU/IDD/TBI service array; knowledge of NC Medicaid program and related requirements preferred.
Experience with trainings/proficiencies related to BH, I/DD, LTSS, and related care management skills.
Preferred experience with I/DD or TBI populations.
EDUCATION & EXPERIENCE REQUIREMENTS
Master\'s degree in a health, psychology, sociology, social work, nursing, or related field. For incumbents with a Master\'s Degree in a Human Services area other than Nursing, the following experience applies:
Two (2) years of experience serving members with mental health conditions.
Two (2) years of prior LTSS and/or Home and Community Based Services coordination, care delivery monitoring, and care management; may be concurrent with MH experience.
For incumbents with a Master\'s Degree in Nursing, four years of full-time mental health experience with the population served is required. This experience may be before or after RN licensure.
*Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104
Licensure/Certification Required:
Valid licensure required. Acceptable licenses include RN, LCSW, LCSWA, LCMHC, LCMHCA, LCMHCS, LPA, HSP-PA, LCAS, LCASA, LMFT or LMFTA.
*Care managers must operate within their scope and collaborate with other disciplines as needed.*
Preferred Work Experience:
Experience working directly with individuals with I/DD or TBI.
PHYSICAL REQUIREMENTS
Close visual acuity for documents and computer work.
Physical activities include crouching, reaching, walking, talking, hearing, and repetitive hand/wrist movements.
Sedentary work with lifting up to 10 pounds; extended sitting.
Mental concentration required; ability to drive and travel to rural areas.
RESIDENCY REQUIREMENT
The person in this position must reside in North Carolina or within 40 miles of the NC border.
SALARY
Depending on qualifications and experience. This position is exempt and not eligible for overtime.
DEADLINE FOR APPLICATION
Open Until Filled
APPLY
Vaya Health accepts online applications in our Career Center. Visit https://www.vayahealth.com/about/careers/
Vaya Health is an equal opportunity employer.
#J-18808-Ljbffr
Remote - must live in or near Jackson 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 Care Manager Licensed Professional ("Care Manager - LP") is responsible for providing proactive intervention and coordination of care to eligible members to ensure they receive appropriate assessment and services. The Care Manager - LP works with the member and care team to identify and alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services across MH, SU, I/DD, TBI, physical health, pharmacy, LTSS, and unmet health-related resource needs. The Care Manager - LP supports and may provide clinical transition planning assistance to state and community hospitals and residential facilities, and tracks individuals discharged from facility settings to ensure follow-up and necessary aftercare services. This is a mobile position with work done in a variety of locations, including members\' home communities. The Care Manager - LP also works with other staff, members, relatives, caregivers, providers, and community stakeholders. The Care Manager - LP utilizes licensed clinical knowledge and skills to assess needs, inform care planning development, provide clinical consultation, and offer recommendations for appropriate care.
As described, essential job functions include, but are not limited to:
Utilization of and proficiency with Vaya\'s Care Management software platform/ administrative health record (AHR)
Outreach and engagement
Compliance with HIPAA requirements, including Authorization for Release of Information (ROI) practices
Performing Health Risk Assessments (HRA): comprehensive bio-psycho-social assessments addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care
Adherence to Medication List and Continuity of Care processes
Participation in interdisciplinary care team meetings and ongoing care management
Transitional Care Management
Diversion from institutional placement
This position is required to meet NC Residency requirements defined by the NC Department of Health and Human Services. The role requires living in or near the counties served to deliver in-person contacts with members and their care teams.
ESSENTIAL JOB FUNCTIONS
Clinical Assessment, Care Planning, and Interdisciplinary Care Team:
Ensures identification, assessment, and person-centered care planning for members.
Links members with necessary formal/informal services across medical and behavioral health areas.
Meets with members to conduct the HRA and gather information on health, behavioral health, medical, and social needs.
Administers screenings (PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and others) and provides education and self-management strategies and linkage to supports.
Assists with medication reconciliation and creates a multisource medication list shared with prescribers.
Supports the care team in developing a person-centered Care Plan addressing mental health, substance use, medical, and social needs and personal goals; ensures elements required by NCDHHS.
Engages with the care team to ensure appropriate assessment and integration of information; resolves barriers and dissatisfaction with services.
Uses clinical skills to review provider assessments for clinical accuracy and may provide consultation to providers as needed.
Interprets and analyzes assessments to support care management activities; engages with provider staff on clinical appropriateness and course of action for complex needs.
Helps members refine treatment goals, identify interventions, and monitor progress.
Informs member/LRP about available services and referral processes; supports choice of providers and objectivity in the process.
Works with members and the care team to address needs and ensure member/LRP involvement; facilitates care team meetings when needed.
Solicits input from the care team and monitors progress; ensures assessment and care plan information is shared with the care team.
Reviews assessments and provides clinical input to ensure needs are addressed; provides crisis plan development and care management in crisis situations as needed.
Updates Care Plans and Care Management assessments at least annually or with significant life changes; supports prevention and population health management education and referrals.
Supports development of a Crisis Plan tailored to member needs and coordinates crisis intervention when necessary in the community.
Supports Transitional Care Management and Diversion efforts for members at risk of institutional care; coordinates with leadership as needed.
Consults with care management leadership and other colleagues to support effective member care.
Collaboration, Coordination, Documentation:
Uses advanced knowledge and licensure to participate in independent decisions affecting clinical outcomes.
Drives initiatives promoting integrated, whole-person care; identifies system barriers with community stakeholders.
Manages and facilitates high-risk team meetings with community partners as appropriate.
Partners with other Vaya departments to address gaps in services and access to care within the catchment area.
Participates in cross-functional meetings and projects; engages in routine multidisciplinary huddles to present complex cases and support CM interventions.
Monitors service provision for quality and compliance with standards; escalates health and safety concerns as needed.
Maintains member satisfaction through ongoing communication and timely follow-up; educates members/families on services and resources.
Verifies Medicaid eligibility and coordinates movement outside the catchment to prevent loss of service.
Ensures documentation in the AHR is complete and accurate; maintains compliance and quality per policy and contracts.
Participates in required trainings and committees as requested.
Other duties as assigned.
KNOWLEDGE, SKILLS, & ABILITIES
Clear and concise communication; effective interpersonal skills.
Ability to drive and sit for extended periods (including in rural areas).
Professional representation of Vaya and relationship-building abilities.
Strong attention to detail and organizational skills.
Independent decision-making with relevant facts.
Problem solving, negotiation, arbitration, and conflict resolution with diplomacy.
Results-oriented with urgency in issue resolution.
Adaptability to multiple demands, shifting priorities, ambiguity, and change.
Proficiency in Microsoft Office and Vaya systems, including care management platform and data analysis.
Ability to shift between macro and micro planning; understand big picture and details.
Utilizes clinical training and licensure to perform assessments and support care management and providers.
Extensive understanding of DSM and MH/SU/IDD/TBI service array; knowledge of NC Medicaid program and related requirements preferred.
Experience with trainings/proficiencies related to BH, I/DD, LTSS, and related care management skills.
Preferred experience with I/DD or TBI populations.
EDUCATION & EXPERIENCE REQUIREMENTS
Master\'s degree in a health, psychology, sociology, social work, nursing, or related field. For incumbents with a Master\'s Degree in a Human Services area other than Nursing, the following experience applies:
Two (2) years of experience serving members with mental health conditions.
Two (2) years of prior LTSS and/or Home and Community Based Services coordination, care delivery monitoring, and care management; may be concurrent with MH experience.
For incumbents with a Master\'s Degree in Nursing, four years of full-time mental health experience with the population served is required. This experience may be before or after RN licensure.
*Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104
Licensure/Certification Required:
Valid licensure required. Acceptable licenses include RN, LCSW, LCSWA, LCMHC, LCMHCA, LCMHCS, LPA, HSP-PA, LCAS, LCASA, LMFT or LMFTA.
*Care managers must operate within their scope and collaborate with other disciplines as needed.*
Preferred Work Experience:
Experience working directly with individuals with I/DD or TBI.
PHYSICAL REQUIREMENTS
Close visual acuity for documents and computer work.
Physical activities include crouching, reaching, walking, talking, hearing, and repetitive hand/wrist movements.
Sedentary work with lifting up to 10 pounds; extended sitting.
Mental concentration required; ability to drive and travel to rural areas.
RESIDENCY REQUIREMENT
The person in this position must reside in North Carolina or within 40 miles of the NC border.
SALARY
Depending on qualifications and experience. This position is exempt and not eligible for overtime.
DEADLINE FOR APPLICATION
Open Until Filled
APPLY
Vaya Health accepts online applications in our Career Center. Visit https://www.vayahealth.com/about/careers/
Vaya Health is an equal opportunity employer.
#J-18808-Ljbffr