School Based Long Term Services & Supports Care Coordinator (Full Time, Hybrid, North Carolina Based)

Alliance Health•Durham, NC

13d•$26 - $33•Hybrid

About The Position

The School-Based LTSS Support Care Coordinator is responsible for assisting public school students with Intellectual Developmental Disability diagnoses and co-occurring complex Mental Health and/or Substance Use navigate behavioral health, physical health and school systems; this position works with members across all insurance plans. The School-Based LTSS Support Care Coordinator shall provide an integrated whole-person approach to identify and link to unmet health-related service and resource needs and use a system of care approach. The School-Based LTSS Support Care Coordinator will communicate with providers of health services and all stakeholders, collaborate with the public school system and Special Education Department as well as other community systems and work in partnership to support the identified population with guidance and planning for students identified as needing support with the IDD eligibility process, Innovations members, and members transitioning to or from placement at a crisis facility. This is a full-time hybrid opportunity. There is an expectation of coming into the Alliance Home Office monthly to attend business meetings. They will also be expected to travel throughout Wake County for business needs. Selected candidate must reside in North Carolina.

Requirements

Bachelor’s degree from an accredited college or university in a human service field and two (2) years of full-time, post-bachelor's degree accumulated I/DD experience with the population served
Or
Bachelor’s degree from an accredited college or university in a non-human service field and four (4) years of full-time, post-bachelor's degree accumulated I/DD experience with the population served
Exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts
Problem-solving and conflict resolution skills
Knowledge of behavioral health and intellectual/developmental disabilities
Knowledge of the purpose and functions of the Department of Social Services, Department of Public Safety, Department of Probation, and the Administrative Office of the Courts
Skilled at shifting between macro- and micro-level planning, maintaining both the big picture and seeing that the details are covered
Skilled in Microsoft Office programs
Detail-oriented with ability to organize multiple tasks and priorities and to effectively manage projects from start to finish
Employment for this position is contingent upon a satisfactory background and MVR (Motor Vehicle Registration) check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.

Responsibilities

Utilize person centered planning, motivational interviewing, and clinical review in Jiva and other SBT platforms to gather information and to identify support or monitoring needed for the individual
Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals
Collaborate across all Alliance Departments, other insurance panel Care Management teams, PLE CMs, Special Educations/EC Departments, Regular Education Depts., DPI, DSS, DJJ, treatment providers, hospital/crisis facilities, other school districts, medical providers, and other community-based supports to facilitate whole person care for members
Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity
Assess and address Social Determinants of Health (SDOH), disparities and/or complex payer issues
Assist individuals/legally responsible persons in choosing service providers; ensuring objectivity in the process
Identify barriers to treatment and gaps in services, and assist individuals with arranging or linking to treatment providers
Consistently evaluates appropriateness of services and ensures implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification
Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapses in care, to include facilitating movement between insurance plans, school systems, and treatment providers
Provide clinical discharge planning assistance to individuals discharged from state/local hospitals, PRTF’s, and other residential settings to assure that they follow up with aftercare services, receive needed assistance to prevent further hospitalizations, and support successful transition back to school setting
Proactively ensure that members have a behavioral health clinical home and a medical home
Collaborate with the school district to address school related concerns, school safety plans, behavioral support and academic transition plans, and special education needs
Complete comprehensive clinical review to assess changes in condition, status of care, insurance changes, at time of referral, with changes of condition, and bi-weekly
Ensure person-centered plans (PCP) are developed by a behavioral health clinical home or, if necessary, by the SB LTSS-Support Care Coordinator to meet urgent needs and to access care for individuals
Verify services are delivered as outlined in the person-centered plan and address any deviations in service
Schedule initial contact with member to verify accuracy of demographic information, identify areas of need in regard to treatment and school-based supports.
Meet with guardian to provide education about SBT, educational supports, TCM, Alliance/applicable insurance plan, and services
Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance
Support members who are in crisis/institutional care settings and require assistance with returning to community-based services
Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management
Complete required activities in all SBT data management systems in compliance with agency, department, and team workflows and expectations
Coordinate with other team members to ensure smooth transition to appropriate level of care
Attend Child and Family team meetings, safety planning meetings, and other treatment meetings with member, natural support and selected providers
Schedule, coordinate and lead team conference calls on behalf of member needs
Communicate with member/LRP to check on status, verify care needs are met and that no new clinical needs warrant further intervention
Provide follow-up coordination with key stakeholders to promote engagement
Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues
Verify that ongoing service adherence is maintained through monitoring
Attend community, provider, stakeholder meetings as needed for member and/or directed to support the needs of the health plan
Maintain medical record compliance/quality, as demonstrated by compliance on QM record reviews, peer reviews, referral source surveys, and individual/group supervision
Obtain and upload all supporting documentation, Legally Responsible Person (LRP) verification, and release of information that will improve care management activity on behalf of the member
Document all applicable member updates and activities per organizational and departmental procedure
Escalate complex cases and cases of concern to Supervisor
Distribute surveys to referral sources and stakeholders
Share appropriate documentation with all involved stakeholders as consent to release is granted
Obtain releases/documentation and provide to all stakeholders involved within the boundaries of FERPA and HIPAA
Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care, to include facilitating movement between insurance plans, school systems, and treatment providers
Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, department, and team documentation standards, and Medicaid and other insurance plan requirements
Proactively monitor own documentation to ensure that issues/errors are resolved as quickly as possible
Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance sponsored events, etc. may be required
Travel to meet with members, providers, stakeholders, attend court hearings, etc., is required