NC Case Management Lead Care Navigator

Sevita•Raleigh, NC

13d•Hybrid

About The Position

Work in conjunction with the Care Manager to deliver integrated, whole-person care management addressing a member’s physical health, behavioral health, intellectual/developmental disability (I/DD), traumatic brain injury (TBI), long-term services and supports (LTSS), and/or pharmacy needs, in addition to unmet health- related resource needs. Provide services in accordance with care management service requirements set by the state and company.

Requirements

At least 18 years old
High School Diploma or G.E.D equivalent
Be a person with lived experience with an I/DD or a TBI with demonstrated knowledge of and direct personal experience navigating the North Carolina Medicaid delivery system; or, a parent or guardian of an individual with an I/DD or a TBI and has at least two years of direct experience providing care for and navigating the Medicaid delivery system on behalf of that individual (parent/guardian cannot serve as an extender for their family member); or, has two years of paid experience performing functions in this job description with at least one year of paid experience working directly with the Tailored Care Management eligible population.
Must meet all agency requirements for pre-employment and those required by state
Ability to perform work with a high degree of quality and autonomy

Nice To Haves

Trained in Tailored Care Management preferred.

Responsibilities

Supports Care Managers in delivering care management.
Engages the member /family/guardian with professionalism, compassion, and purpose through telephonic and virtual methods and in-home visits as required. Interactions should be concise, respectful, in a language of his/her choice, and non-judgmental.
Establishes a professional rapport with all team members, stakeholders, peers and supervisors.
Initiates the first contact with the member/family/guardian to complete the preliminary questionnaire.
Communicates with the Case Manager any information pertaining to the care and well-being of the member/family/guardian.
Provides documentation of billable events that align with minimum contact expectations to the Care Manager.
Maintains an accurate, up-to-date electronic information data stream on all interactions, encounters, activities, and communications with the member/family/guardian.
Performs general outreach, engagement, and follow up with members, to encourage accomplishment of goals set in the Plan//ISP.
Coordinates services/appointments.
Engages in health promotion activities and knowledge sharing.
Shares information with the Care Manager and other members of the care team on the member’s circumstances.
Provides and tracks referrals and provides information and assistance in obtaining and maintaining community- based resources and social support services.
Participates in case conferences and planning meetings.
Supports the Care Manager in Identifying and addressing barriers to services, gaps in service, and unmet health- related needs proactively, expanding relationships and linkages to aid in meeting member’s needs.
Provides services that meet national, state, and local healthcare standards at the highest level.
Reports issues of concern, general departmental activities and staffing needs to the Care Manager.
Completes all required training and participates in educational sessions to improve overall skills.
Attends industry meetings, training, and functions to promote positive relationships with stakeholders.
Participates in quality improvement and measurement activities to achieve identified targets and outcomes.
Performs other related duties and activities as required.