We are currently seeking Care Managers DSS/DJJ to serve members in Mecklenburg, Wake, Durham, Cumberland, Johnston and Orange counties.
This position will allow the successful candidate to work a schedule which will include both onsite as well as remote work 4 days of the week as approved by their supervisor.
The Care Manager II position leads all communication among care team members and is the primary point of contact for members connected to Department of Social Services, Department of Juvenile Justice, and other multi-system involvement. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services.
Responsibilities & Duties
Complete comprehensive assessments at enrollment, yearly or at changes in condition
Develop Plans of Care derived from the completed assessments
Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities
Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity
Assign Plan of Care activities to Community Health Worker if member has identified 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
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
Utilize person centered planning, motivational interviewing and historical review of assessments in Jiva to gather information and to identify supports 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
Submit required documentation to UM to ensure timely delivery of services and trouble shoot until authorization is obtained. Notify providers of successful authorization
Participate in child and family team meetings, and/or other DSS/DJJ-defined meetings to support plans of care and cross-system communication and collaboration
Provide Support and Monitoring
Schedule initial contact with member to verify accuracy of demographic information
Update inaccurate information from the Global Eligibility File
Schedule face to face meeting with member/Legally Responsible Person (LRP) to provide education about Alliance, Care Teams, 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.
Refer members who are in crisis/institutional care settings and require assistance with returning to community-based services, to the Integrated Health Consultant
Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management
Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment
Coordinate with other team members to ensure smooth transition to appropriate level of care.
Attend treatment meeting with member, natural supports and selected providers.
Schedule, coordinate and lead team conference calls on behalf of member needs
Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment
Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues
Verify that ongoing service adherence is maintained through monitoring
Provide clinical and administrative consultation for DSS and DJJ
Provide system navigation for DSS and DJJ to understand and work within the behavioral health system
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
Open new episodes in JIVA and schedule initial contact with member to verify accuracy of demographic information
Document all applicable member updates and activities per organizational procedure
Escalate complex cases and cases of concern to Supervisor
Distribute surveys to members in service
Ensure that service orders/doctor’s orders are obtained, as applicable
Share appropriate documentation with all involved stakeholders as consent to release is granted
Obtain releases/documentation and provides to all stakeholders involved.
Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information
Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care
Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements
Education & Experience
Master’s degree in Human Services or related field and at least two years of full-time, post graduate degree, MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active, valid NC clinical license;
Graduation from a school of nursing and licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active, valid Registered Nursing license
Knowledge and experience collaborating with county departments of social services, department of juvenile justice, crisis response, and community-based treatment providers including training highly preferred.
NC Clinical license (RN, LCSW, LCMHC, LPA, or LMFT)
Care Management Certification preferred
Knowledge, Skills, & Abilities
Person Centered Thinking/planning
Knowledge of using assessments to develop plans of care
Knowledge of Diagnostic and Statistical Manual of Mental Disorders
Knowledge of LOC process, SIS for IDD and FASN assessment for TBI
Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans
Knowledge of and skilled in the use of Motivational Interviewing
Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
Strong interpersonal and written/verbal communication skills essential, including
Conflict management and resolution skills
High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
Ability to make prompt, independent decisions based upon relevant facts
$50,865.49 to $87,563.63