We are seeking Care Managers-TBI to serve Mecklenburg or Wake county members.
The Care Manager I-TBI position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a Comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relay communication among providers of health services.
This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work 4 days of the week as approved by their supervisor. This position will require travel within the communities Alliance serves as needed.
Responsibilities & Duties
Complete Assessment/Planning
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 (LRP in choosing service providers; ensuring objectivity in the process.
Consistently evaluate appropriateness of services and ensure 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 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 shoots until authorization is obtained. Notifies providers of successful authorization.
Notify providers of successful authorization.
For Medicaid C, enlists administrative support to send Level of Care (LOC) and initial Individual Service Plan (ISP) to Department of Social Services (DSS) to turn on special waiver program indicator. Verify that necessary Client, Employer, Group (CEG) enrollments are correct in Jiva, and that Medicaid eligibility is updated in Alpha.
Provide Support and Monitoring to Members
Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information from the Global Eligibility File.
Completes activities related to Plans of Care
Coordinate and participate with SIS Team to ensure successful completion of SIS assessment within time frames allotted.
For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.
Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan.
Schedule and facilitate the ISP meeting.
Develop and update ISP
Submit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver.
Coordinate with other team members to ensure smooth transition to appropriate level of care.
Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.
Complete Home and Community Based Services (HCBS) Notice of Change Form when arranging new HCBS service placement (for Residential Supports, Day Supports, and Supported Employment) with a new provider and submit to Provider Network department to ensure successful transition to provider.
Refer provider contractual concerns to Provider Networks.
Update other Care Team members of urgent or pertinent treatment updates
Recognize and report critical incidents to supervisors and Quality Management.
Schedule face to face meeting with member/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.
Escalate complex cases and cases of concern to Supervisor.
Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.
Verify ongoing service adherence with member and/or guardian
Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care.
Complete Documentation
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.
Distribute surveys to members in service.
Ensure that service orders/doctor’s orders are obtained, as applicable.
Obtain releases/documentation and provide to all stakeholders involved.
Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information
Knowledge of using assessments to develop plans of care
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
Knowledge of and skilled in the use of Motivational Interviewing techniques
Strong interpersonal and written/verbal communication skills
Conflict management and resolution skills
Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
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
Minimum Education & Experience
Master’s degree Health, Psychology, Sociology, Social Work, Nursing or another relevant human services area and one (1) year of experience with Traumatic Brain Injuries (TBI),
or
Bachelor’s degree in Health, Psychology, Sociology, Social Work, Nursing or another relevant human services area and two (2) years of experience with Individuals with Traumatic Brain Injuries (TBI)
Or
Graduation from an accredited Nursing program and licensure as a Registered Nurse
