Tailored Care Management (TCM) Care Manager.

Pathways to Life•Durham, NC

About The Position

Pathways to Life, Inc. is seeking a dedicated and highly organized Tailored Care Manager (TCM) to join our team. The TCM plays a pivotal role in supporting individuals with complex behavioral health and/or intellectual and developmental disabilities (I/DD) needs by coordinating care across multiple systems. The ideal candidate is a licensed or credentialed human services professional with a passion for advocacy and whole-person care. This position is perfect for someone who excels in care coordination, relationship-building, and ensuring compliance with NC Medicaid’s Tailored Plan requirements . Summary of Position Responsibilities The Tailored Care Manager is responsible for assessing, planning, coordinating, monitoring, and advocating for services and supports to improve health outcomes and overall quality of life for members. This role requires collaboration with clients, families, providers, community partners, and stakeholders to ensure person-centered care that addresses the medical, behavioral, and social determinants of health. The TCM ensures that all activities comply with NC Medicaid Tailored Care Management Clinical Coverage Policy and other regulatory requirements.

Requirements

Education: Bachelor’s degree in Human Services, Social Work, Psychology, Nursing, or related field.
Experience: Minimum of two years of experience providing care coordination or case management to individuals with behavioral health or I/DD needs.
Licensure/Certification: Must hold or be eligible for one of the following: LCSW, LCMHC, LMFT, RN, LCAS, or equivalent licensure.
Knowledge: Familiarity with NC Medicaid Tailored Care Management, person-centered planning, and community resources.
Skills: Strong organizational, time management, and problem-solving skills. Excellent written and verbal communication abilities. Ability to work independently while collaborating with a multidisciplinary team.
Additional Requirements: Valid driver’s license and reliable transportation.
Current certifications in NCI (Nonviolent Crisis Intervention) and CPR/First Aid , or willingness to obtain.

Nice To Haves

Master’s degree preferred.
Certified Care Manager credentials preferred or must be obtained within state-required timelines.

Responsibilities

Assessment & Care Planning Conduct initial and ongoing comprehensive assessments to identify client strengths, needs, and goals.
Develop and update person-centered care plans (PCPs) that incorporate physical health, behavioral health, and social support needs.
Ensure care plans are completed timely and in compliance with Tailored Care Management standards.
Care Coordination & Service Linkage Facilitate access to services by coordinating with health providers, behavioral health teams, DSS, schools, and other community resources.
Address barriers to care, including housing, transportation, and employment needs, through referrals and advocacy.
Track member progress and ensure services are implemented as planned.
Member & Family Engagement Build trusting relationships with clients and families, ensuring their voice drives treatment planning and decisions.
Provide education about health conditions, treatment options, and available resources.
Support families through system navigation and crisis situations.
Crisis Support Participate in crisis response planning and assist with de-escalation when needed.
Develop safety plans and coordinate with crisis response teams and emergency services.
Documentation & Compliance Maintain accurate, timely, and complete documentation in electronic health record systems (e.g., Pangaea).
Submit required forms, assessments, and reports within designated timelines.
Ensure compliance with HIPAA, Tailored Care Management policies, and Medicaid regulations.
Monitoring & Quality Assurance Conduct regular follow-ups to monitor progress toward care plan goals.
Participate in internal audits, quality reviews, and accreditation activities.
Track and report member outcomes for performance improvement.
Team Collaboration Work closely with other care managers, supervisors, and clinical staff to promote consistent, coordinated services.
Attend team meetings, case reviews, and required agency trainings.