Innovations Care Manager (QP)-Mobile/Remote (NC)

Partners Behavioral Health Management•Mocksville, NC

11d•Remote

About The 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.

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
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
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
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.

Nice To Haves

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

Responsibilities

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
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
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
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
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
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
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