CM Manager (Cherokee, Clay, Graham, or Macon County, NC)

Vaya Health•Murphy, NC

9h•Remote

About The Position

Care Management Manager (“CM Manager”) is responsible for providing day to day coaching to assigned Care Management staff to ensure responsibilities are carried out effectively and accurately. The CM Manager is also responsible for knowing and implementing NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services standards and organizational policies. CM Manager is responsible for providing oversight of the Care Management team as they are 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 CM Manager is responsible for determining eligibility for care management when eligibility is not clear. The CM Manager may work with staff, and members, if necessary, in the communities. CM Manager works with the assigned Care Manager, member and care team to 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. CM Manager works with the assigned Care Managers who support and may provide 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 [i.e. member’s home community, provider office(s)]. CM Manager also works with other Vaya staff, members and family members, providers as well as community stakeholders. As further described below, essential job functions of the CM Manager include, but may not be 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): a comprehensive bio-psycho-social assessment 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, comprehensive care planning, and ongoing care management Transitional Care Management Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”). This position is required to live in or near the counties served to effectively oversee care management and stakeholder relationships.

Requirements

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 to effectively negotiate and resolve issues with minimal assistance.
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 and 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, however delivered, including but not limited to the following:
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
A Master’s Degree in a field related to health, psychology, sociology, social work or another relevant human services area and three (3) years of experience providing care management, case management, or care coordination to the population being served
A Master’s Degree in nursing and five (5) years of experience providing care management, case management, or care coordination to the population being served
A Master’s Degree in a field related to health, psychology, sociology, social work or another relevant human services area 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).
A Master’s Degree in nursing and Registered Nurse (RN)
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.
The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

Nice To Haves

Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred.
Two (2) years of supervisory experience preferred.

Responsibilities

Effectively implement organizational priorities, quality initiatives and programs through the CM Team.
Provide administrative direction and clinical guidance to their team(s) regarding member care and community collaboration activities.
Demonstrate proficiency in team workflows and use of technology used by CMs to complete routine work.
Represent Vaya Health, as well as their department/Division, at designated community stakeholder, provider or Department of Health and Human Service-related meetings.
Provide supervision to Care Manager team by observing and monitoring paperwork/documentation to ensure Care Management activities are carried out in an effective manner.
Conduct employee coaching to ensure continuous improvement of performance in meeting the needs of the members and communities. Coaching includes both in person observation as well as documentation review.
Conduct performance reviews as required and conduct employee trainings and job simulation exercises to include but not limited to policies and procedures and service definitions.
Work with staff and members to identify barriers and help resolve dissatisfaction with services or community-based interventions.
May provide direct CM activities in situations that require such as staff shortages or an elevated need for services or oversight.
Utilize data and reports frequently and consistently to monitor staff performance toward contract requirements.
Ensure effective and quality care management functions are provided to eligible members.
CM Manager confirms CM meet with members to conduct a comprehensive bio-psycho-social assessment in order to gather information on their overall health, including behavioral health, developmental, medical and social needs.
Reviews clinical assessments conducted by providers and partners with Care Manager for clinical consultation as needed to ensure all areas of the member’s needs are addressed.
CM Manager ensures Care Manager administers the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings within their scope based on member’s needs. The Care Manager uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports.
The assessment process includes reviewing and transcribing member’s current medication and entering information into Vaya’s Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care.
Uses clinical skills and expertise to review clinical assessments conducted by providers to ensure all areas of the member’s needs are addressed, when needed. CM Manager may review for clinical accuracy and may provide consultation and technical support to providers as needed based on reviews.
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.
Ensures CMs provide clinical assessment, within their scope, in situations where the member’s lack of clinical home or available network provider creates significant risk to member well-being (e.g., need for time sensitive placement/ discharge from inpatient setting)
CM Manager ensures the CM 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 that help them live the life they want in the community of their choice.
Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals
Ensure the Care Plan includes all elements required by NCDHHS
Use information collected in the assessment process to learn about member's needs and assist in care planning
Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary
Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions
CM Managers confirm CM works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved.
CM Manager makes sure CM supports and facilitates care team meetings, as needed, where member Care Plan is discussed and reviewed, and that the CM solicits input from the care team and monitors progress.
CM Manager ensures that the assessment, Care Plan, and other relevant information is provided to the care team and that Care Plans and Care Management assessments are updated at a minimum of annually or when there is a significant life change for the member.
CM Managers confirms the CM supports Transitional Care Management responsibilities for members transitioning between levels of care and coordinates diversion efforts for members at risk of requiring care in an institutional setting.
CM Managers ensures care managers consult with care management licensed professionals, RNs, doctors, 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.
CM Manager oversees, and may at times provide, services in situations that require such as staff shortages or an elevated need for oversight or services. Serves as a collaborative partner in identifying system barriers through work with community stakeholders.
Provide clinical and administrative consultation for DSS social workers, when needed.
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.
Participate in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CM’s and receiving support and feedback regarding CM interventions for clients’ medical, behavioral health, intellectual /developmental disability, medication, and other needs.
Works with Care Managers in participating in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. 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.
Ensures CM promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues.
Verifies member’s continuing eligibility for Medicaid, as needed, and ensures CMs proactively respond to a member’s planned movement outside Vaya’s catchment area to ensure changes in their Medicaid County of eligibility are addressed prior to any loss of service.
Proactively and timely oversees creation of and monitors documentation within the AHR to ensure CM’s completeness, accuracy and follow through on care management tasks.
Maintains electronic AHR compliance and quality according to Vaya policy.
Works with Care Manager, LP and Care Manager Embedded, LP to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya’s contracts with NCDHHS.
Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies.
Participates in Vaya committees, workgroups, and other efforts that may require clinical knowledge, as requested, and identified.