Innovations Care Manager (QP) - Mobile, Iredell County, NC

Position eligible for –

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details.

Office Location: Mobile position; available for Iredell County, NC.

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of Position:

The Innovations Care Manager is responsible for providing Tailored Care Management for members with intellectual/developmental disabilities enrolled in the NC Innovations waiver. The Innovations Care Manager is responsible for addressing members’ whole-person needs alongside coordinating and monitoring their waiver services. The Innovations Care Manager actively engages with members through comprehensive assessment, care planning, health promotion, and comprehensive transitional care. If members enrolled in the waiver opt out of Tailored Care Management, the member will remain enrolled in the waiver and the Care Manager will provide Care Coordination to monitor and coordinate waiver services. Travel is an essential function of this position.

Role and Responsibilities:

Duties of the Innovations Care Manager include, but are not limited to, the following:

Comprehensive Care Management

• Provide assessment and care management services aimed at the integration of primary, behavioral and specialty health care, and community support services, using a comprehensive person-centered care plan which addresses all clinical and non-clinical needs and promotes wellness and management of chronic conditions in pursuit of optimal health outcomes
• Complete a care management comprehensive assessment within required timelines and update as needed
• Develop a comprehensive Individual Support Plan and update as needed
• Ensure that the member/legally responsible person (LRP) and all others responsible for plan implementation sign the plan and updates
• Educate members/LRP on methodology for budget development, total dollar value of the budget and mechanisms available to modify the member budget.
• Educate the member/LRP on waiver requirements/limits, however, ensures services, as requested are outlined in the budget.
• Secure service authorizations for all Innovations waiver services
• Ensures that service orders/doctor’s orders are obtained, as applicable
• Provide diversion activities to support community tenure
• Monitor services based on Innovations Waiver, Home and Community Based Standards and Tailored Plan requirements

Care Coordination

• Facilitate access to and the monitoring of services identified in the Individual Support Plan to manage chronic conditions for optimal health outcomes and to promote wellness.
• Facilitate communication and regularly scheduled interdisciplinary team meetings to review care plans and assess progress.
• Make announced/unannounced monitoring visits, including nights/weekends as applicable
• Monitor services for compliance with state standards, waiver requirements, and Medicaid regulations, as applicable
• Monitor to ensure that any restrictive interventions (including protective devices used for behavioral support) are written into the ISP and the Positive Behavior Support Plan
• Verify that services are delivered as outlined in person centered plan and addresses any deviations in services
• Notify Utilization Management of any suspected or actual changes in level of care
• Monitor compliance with home and community-based standards

Individual and Family Supports

• Provide education and guidance on self-management and self-advocacy
• Provide information to the member about the member’s rights, protections, and responsibilities, including the right to change providers, the grievance and complaint resolution process, and fair hearing processes
• Help members make informed choices of care team participants, provide information about providers, and arrange provider interviews as needed

Health Promotion

Transitional Care Management

• Facilitation of services for the member and family/caregiver when the member is experiencing care transitions (including, but not limited to transitions related to hospitalization, nursing facility, rehabilitation facility, community-based group home, etc.), significant life changes including, but not limited to loss of primary caregiver, transition from school services, etc.) or when a member is transitioning between health plans.
• Create and implement a 90-day transition plan as an amendment to the member’s ISP that outlines how the member will maintain or access needed services and supports, transition to the new care setting, and integrate into his or her community.
• Proactively responds to a member’s planned movement outside the LME/MCO geographic area to ensure changes in their Medicaid County of eligibility are addressed prior to any loss of service

Referral to Community/Social Supports

• Provide information and assistance in referring members to community-based resources and social support services, regardless of funding source, which can meet identified needs
• Provide comprehensive assistance securing health-related services, including assistance with initial application and renewal with filling out and submitting applications and gathering and submitting required documentation, including in-person assistance when it is the most efficient and effective approach

Other:

• Verify member’s continuing eligibility for Medicaid with Indicators and promptly follows-up on identified issues, as indicated
• Coordinate Medicaid deductibles, as applicable, with the member/legally responsible person and provider(s)
• Proactively monitor own documentation/billing to ensure that issues/errors are resolved as quickly as possible
• Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements
• Maintain medical record compliance/quality, as demonstrated by ≥90% compliance on Qualitative Record Reviews
• Document within the grievance system any expression of dissatisfaction/concern expressed by members supported or others on behalf of the member supported
• Ensure strong leadership to care team, including effectively communicating with and providing direction to Care Management extenders

Knowledge, Skills and Abilities:

• Demonstrated knowledge of the assessment and treatment of I/DD needs, with or without co-occurring physical health, mental health or substance use disorder needs
• Ability to develop strong, person-centered plans
• Exceptional interpersonal skills, highly effective written and oral communication skills, and the propensity to make prompt independent decisions based upon relevant facts and established processes
• Demonstrated ability to collaborate and communicate effectively in team environment
• Ability to maintain effective and professional relationships with members, family members and other members of the care team
• Problem solving, negotiation and conflict resolution skills
• Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
• Detail oriented
• Ability to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiries
• Ability to independently organize multiple tasks and priorities and to effectively complete duties within assigned timeframes
• Ability to manage and uphold integrity and confidentiality of sensitive data
• Sensitivity and knowledge of different cultures, ethnicities, spiritual beliefs and sexual orientation.

Education and Experience Required:

• Bachelor’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area and two (2) years of full-time experience with I/DD population OR
• Bachelor’s degree in a field other than human services and four (4) years of full-time experience with I/DD population OR
• Master’s degree in human services and one (1) year of full-time experience with I/DD population OR
• Licensure as a registered nurse (RN) and four (4) years of full-time accumulated experience with I/DD

AND

• Two (2) years of prior Long-Term Services and Supports (LTSS) and/or Home and Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working with I/DD population described above

AND

• Must reside in North Carolina or within 40 miles of the NC border
• Must have ability to travel regularly as needed to perform job duties

Education/Experience Preferred:

Experience working with members with co-occurring physical health and/or behavioral health needs preferred.

Licensure/Certification Requirements:

If a Registered Nurse (RN), must be licensed in North Carolina.