Screening & Referral Specialist

Partners Behavioral Health Management•Morganton, NC

2h•Remote

About The Position

The Screening and Referral Specialist performs intermediate administrative work as well other qualified professional duties related to overseeing the coordination and management of care for members and recipients. The Screening & Referral Specialist is responsible for providing outreach, screening and care coordination for members not receiving Tailored Care Management. Support provided is telephonic or via two-way audio-visual contact with referral to community-based teams when indicated for transitional care. The Screening and Referral Specialist will assist members and recipients with requests to change Care Managers, Opt-out, or engage/re-engage with Care Management. This position requires perseverance in efforts to locate and contact members and will require flexibility in work hours, with some early evening hours required in order to effectively contact as many members as possible to engage them in Tailored Care Management or complete Care Needs Screenings. This position will ensure accurate documentation in NCFAST portal regarding Care Manager assignment. This position will complete Care Needs Screenings for members who are ineligible for Care Management or have chosen to Opt-Out. This position will assist with securing and monitoring Care Coordination efforts for recipients enrolled in state benefits. This position is a member of the Care Connection Team. This is a mobile position with work done in a variety of locations.

Requirements

Must have ability to travel as needed to attend required in-person meetings/trainings.
Knowledge of Tailored Plan, NC Medicaid Direct, and state funded benefits.
Comprehensive knowledge of care needs screening timelines and processes for both Tailored Plan and Medicaid Direct contracts.
Exceptional interpersonal and communication skills.
Excellent computer skills including proficiency in Microsoft Office products (Word, Excel, Outlook, and PowerPoint).
Detail-oriented, able to organize multiple tasks and priorities and effectively manage projects from start to finish.
Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships.
Ability to change the focus of his/her activities to meet changing priorities.
A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
Skill and ability to demonstrate diplomacy as well as the ability to handle stressful situations.
Ability to demonstrate initiative and effective, solution-focused, problem-solving skills.
Ability to assess personal strengths/needs and identify needed training to promote own professional development.
Bachelor’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area or licensure as an RN; and two (2) years of experience providing care management, case management, or care coordination to complex individuals with BH, I/DD or TBI; OR Bachelor’s degree in a non-human services field and four (4) years of experience providing care management, case management, or care coordination to complex individuals with BH, I/DD or TBI.
Two (2) years of prior Long Term Support Services and/or Home and Community Based Standards coordination, care delivery monitoring and care management experience. This experience may be concurrent with years of experience working directly with individuals with BH, I/DD, or a TBI, as described above.
Must reside in North Carolina.

Nice To Haves

Experience working with individuals with co-occurring physical health and/or behavioral health needs preferred.
If a Registered Nurse (RN), must be licensed in North Carolina.

Responsibilities

Outreach for Members: Communicate with members and recipients via phone to field questions and provide education on the TCM approaches, request to change CM process, and Opt-out process.
Care Needs Screenings / Care Coordination: Coordinate a range of scenarios, which require a wide array of potential responses including, but not limited to informing, researching, linking, assessing need, reviewing documentation, phone communication, and consultation.
Complete initial Care Needs Screenings for members who are ineligible to receive TCM due to receiving a service which is duplicative or excluded.
Complete initial and annual Care Needs Screenings for members who have opted out of receiving TCM, again providing opportunity for engagement in TCM.
Connect members not participating in TCM with transitional care as necessary.
Communicate with members and recipients via phone to field questions and provide education on the TCM approaches, request to change CM process, and Opt-out process.
Collaboration with Primary Care Case Management (PCCM) Vendor (currently CCNC) and Other Care Management Entities: Be responsive to requests from other entities providing care management to members ineligible for Tailored Care Management.
Receive and respond to inquiries from PCCM care managers, and any other care or case manager assigned to or responsible for a member, with quick provision of help to callers (within 24 hrs for urgent situations, within 3 business days for non-urgent situations).
Check the PCCM Care Management Information System to determine whether the member is also being managed by a PCCM care manager.
Coordinate with each member’s care manager as needed to the extent the member is engaged in care management through another entity (e.g., PCCM Vendor, Skilled Nursing Facility, CAP/C or CAP/DA, etc.).
Share the results of the any assessments conducted, the member’s person-centered plan, and the member’s Care Plan (to the extent one exists) with entity providing care management.
Link member with Partners transitional care team or community care management team.
Accept care coordination referrals from primary care providers and care managers from other entities, determine what level of care coordination services are needed, and provide referral status feedback to the referring provider or care manager within five (5) business days.
Initiate care management and physical health referrals to the PCCM vendor as such needs are identified and receive and document feedback from the PCCM vendor regarding the referral status.
Documentation/Other Duties: Ensure accurate documentation in TruCare and Alpha+ regarding Care Manager assignment.
Assist in identification of barriers to case load management and in development of strategies to address said barriers.
Track and report performance measures to supervisor as assigned.
Document accurately, comprehensively, and timely all contacts and other care coordination functions.
Facilitate the integration of continuous quality improvement.
Perform related tasks as assigned.
Ensure that work hours are adjusted, when necessary, to maximize successful contacts with members.