Care Manager - LP (Buncombe County, NC)

Vaya Health•Asheville, NC

4d•$62,994 - $81,892•Hybrid

About The Position

The Care Manager Licensed Professional (“Care Manager - LP”) is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals 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 needed by the member across the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs networks. Care Manager - LP supports and may provide clinical transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. 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 Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. The Care Manager - LP also utilizes licensed clinical knowledge and skills to assess needs, inform care planning development, provide clinical consultation, and offer recommendations for appropriate care. Essential job functions include utilization of Vaya’s Care Management software, outreach and engagement, HIPAA compliance, performing Health Risk Assessments (HRA), adherence to medication and continuity of care processes, participation in interdisciplinary care team meetings, comprehensive care planning, ongoing care management, transitional care management, diversion from institutional placement, and meeting NC Residency requirements.

Requirements

Master’s degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area.
For incumbents with a Master’s Degree in a Human Services Area besides Nursing, two (2) years of experience working directly with individuals with BH conditions.
For incumbents with a Master’s Degree in a Human Services Area besides Nursing, two (2) years of prior Long-term Services and Supports and/or Home Community Based Services coordination, care delivery monitoring and care management experience.
For incumbents with a Master’s Degree in Nursing, four years of full-time accumulated experience in mental health with the population served.
Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104.
Valid licensure required. Acceptable licenses are Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Clinical Social Worker Associate (LCSWA), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Clinical Mental Health Counselor Associate (LCMHCA), Licensed Clinical Mental Health Counselor Supervisor (LCMHCS), Licensed Psychological Associate (LPA), Health Services Professional Psychological Associate (HSP-PA), Licensed Clinical Addiction Specialist (LCAS), Licensed Clinical Addiction Specialist Associate (LCASA), Licensed Marriage and Family Therapist (LMFT) or Licensed Marriage Family Therapist Associate (LMFTA).
Ability to express ideas clearly/concisely and communicate in a highly effective manner.
Ability to drive and sit for extended periods of time (including in rural areas).
Exceptional interpersonal skills and ability to represent Vaya in a professional manner.
Ability to initiate and build relationships with people in an open, friendly, and accepting manner.
Strong attention to detail and superior organizational skills.
Ability to make prompt independent decisions based upon relevant facts.
Well-developed capabilities in problem solving, negotiation, arbitration, and conflict resolution, including a high level of diplomacy and discretion.
A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure.
Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change.
Thorough knowledge of standard office practices, procedures, equipment, and techniques.
Intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research.
Must be highly skilled at shifting between macro and micro level planning, maintaining both the big picture, and seeing that the details are covered.
Ability to use higher-level clinical training and licensure to perform clinical assessments, drive positive outcomes for members, support care management colleagues, and offer clinical assistance to providers.
Highly skilled at performing clinical assessments of members and identifying member needs.
Extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers.
Ability to complete and maintain all trainings and proficiencies required by Vaya.

Nice To Haves

Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred.
Experience working directly with individuals with I/DD or TBI.
BH I/DD Tailored Plan eligibility and services.
Whole-person health and unmet resource needs (ACEs, trauma-informed care, cultural humility).
Community integration (independent living skills; transition and diversion, supportive housing, employment, etc.).
Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.).
Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination).
Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.).
Serving members with I/DD or TBI (understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.).
Serving children (child-and family-centered teams, Understanding the “System of Care” approach).
Serving pregnant and postpartum women with SUD or with SUD history.
Serving members with LTSS needs (Coordinating with supported employment resources).

Responsibilities

Ensures identification, assessment, and appropriate person-centered care planning for members.
Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home).
Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs. Administers screenings like PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and others based on member’s needs.
Reviews and transcribes member’s current medication and enters information into Vaya’s Care Management platform.
Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals.
Ensures the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals.
Ensures the Care Plan includes all elements required by NCDHHS.
Uses information collected in the assessment process to learn about member's needs and assist in care planning.
Ensures members of the care team are involved in the assessment as indicated by the member/LRP and uses clinical skills to evaluate and incorporate other available clinical information into the assessment as necessary.
Works with members to identify barriers and help resolve dissatisfaction with services or community-based interventions.
Uses clinical skills and expertise to review clinical assessments conducted by providers to ensure all areas of the member’s needs are addressed.
Interprets and analyzes clinical assessments to draw clinical conclusions to support care management activities.
Engages with provider clinical staff to determine clinical appropriateness and course of action when assessments present a wide array of treatment options and members present with complex needs.
Helps members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals.
Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes (e.g., requirements for specific service), etc.
Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process.
Works in an integrated care team including, but not limited to, an RN and pharmacist along with the member to address needs and goals.
Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed.
Solicits input from the care team and monitor progress.
Ensures that the assessment, Care Plan, and other relevant information is provided to the care team.
Reviews assessments conducted by providers and consult with clinical staff as needed to ensure all areas of the member’s needs are addressed.
Provide clinical assessment in situations where the member’s lack of clinical home or available network provider creates significant risk to member well-being.
Updates Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member.
Supports and assists with education and referral to prevention and population health management programs.
Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member.
Provides crisis intervention, coordination, and care management if needed while with members in the community.
Supports Transitional Care Management responsibilities for members transitioning between levels of care.
Coordinates Diversion efforts for members at risk of requiring care in an institutional setting.
Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care.
Utilizes advanced knowledge in their work which requires use of their advanced degree and licensure to be able to participate and initiate independent decisions with matters of significance and drive positive clinical outcomes for Vaya members.
Executes independent discretion and engages in business decisions for the Vaya Care Management Department that support initiatives to promote Vaya’s integrated, whole-person care model for members.
Serves as a collaborative partner in identifying system barriers through work with community stakeholders.
Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate.
Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya’s catchment.
Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization.
Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs.
Participates in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership.
Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards.
Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed.
Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders.
Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues.
Supports and assists members/families on services and resources by using educational opportunities to present information.
Verifies member’s continuing eligibility for Medicaid, and proactively responds to a member’s planned movement outside Vaya’s catchment area.
Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks.
Maintains electronic AHR compliance and quality according to Vaya policy.
Ensures all clinical and non-clinical documentation meet all applicable federal, state, and Vaya requirements.
Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies.
Participates in Vaya committees, workgroups, and other efforts that require clinical knowledge, as requested, and identified.
Other duties as assigned.