TCM Care Manager - Alliance Catchment Area

Healthkeeperz

2d•Hybrid

About The Position

The Care Manager is part of a multidisciplinary care team providing whole-person care management for Behavioral Health I/DD Tailored Plan beneficiaries. The role spans multiple domains, including physical health, behavioral health, I/DD, traumatic brain injury (TBI), pharmacy, long-term services and supports (LTSS), and unmet health-related resource needs.

Requirements

A Bachelor’s degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area, or licensure as a registered nurse (RN)
Two years of experience working directly with individuals with behavioral health conditions, I/DD or TBI condition(s)
For Care managers serving members with LTSS needs: two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
Proficiency in Person-Centered Thinking/planning
Experience using assessments to develop plans of care
Knowledge of LOC processes
Familiarity with Medicaid basic, enhanced MHSUD, and waiver benefits plans
Proficiency in using Motivational Interviewing techniques
Strong interpersonal and written/verbal communication skills
Conflict management and resolution skills
Proficiency in Microsoft Office products
Ability to make prompt, independent decisions
Good organizational skills to prioritize duties and meet deadlines

Responsibilities

Conduct comprehensive assessments at enrollment, yearly, or during changes in condition.
Develop, update, and facilitate Care Plans derived from these assessments.
Utilize person-centered planning, motivational interviewing, and historical review of assessments to identify required supports.
Address Social Determinants of Health (SDOH), disparities, and complex payer issues in the Plan of Care.
Assign interventions/plans of care to Extenders [KO1] [JC2] for monitoring and service engagement.
Coordinate with team members for smooth transitions to appropriate levels of care.
Participate in the agency’s twenty-four (24) hour coverage for care management.
Educate members/Legally Responsible Persons (LRP) about care teams, services, rights, the grievance and appeals process, available service options, and payer requirements.
Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.
Ensure adherence to service orders/doctor’s orders and obtain necessary releases/documentation.
Submit necessary documentation to the payer for timely service delivery.
Maintain all certifications or licensure required for the position and comply with all agency policies and procedures.
Evaluate the appropriateness of services and ensure the implementation of the plan of care through regular assessments.
Escalate complex cases to the Supervisor and report critical incidents.
Attend Behavior Support Plan (BSP) meetings.
Assist individuals/LRP in choosing service providers, ensuring objectivity.
Utilize Admission, Discharge, and Transfer (ADT) information to support members admitted, transferred, or discharged from a facility promptly.
Collaborate with the care team and service providers to develop plans reflecting the individual’s needs and desired life goals.
Complete all other responsibilities as assigned by the supervisor.
Visiting members at their living arrangements, such as their own home, a relative's home, a care facility, or any other location, is essential and required to ensure the delivery of high-quality care.