Care Manager – LP (Transylvania County, NC) Position Available In Brevard, Florida

Job Description:

LOCATION

Remote

• must live in or near Transylvania County,North Carolina.

The person in this position is required to maintainresidency in North Carolina or within 40 miles of the NC border.

This position requires travel.

GENERAL STATEMENT OF JOB

The Care Manager Licensed Professional(“Care Manager

• LP”) is responsible for providing proactiveintervention and coordination of care to eligible Vaya Healthmembers and recipients (“members”) to ensure that these individualsreceive appropriate assessment and services. The Care Manager
• LPworks with the member and care team to identify and alleviateinappropriate levels of care or care gaps through assessment,multidisciplinary team care planning, linkage and/or coordinationof services needed by the member across the MH, SU, intellectual/developmental disability (“I/DD”), traumatic brain injury (“TBI”)physical health, pharmacy, long-term services and supports (“LTSS”)and unmet health-related resource needs networks.

Care Manager

• LPsupports and may provide clinical transition planning assistance tostate, and community hospitals and residential facilities and trackindividuals discharged from facility settings to ensure they followup with aftercare services and receive needed assistance to preventfurther hospitalization.

This is a mobile position with work donein a variety of locations, including members’ home communities. TheCare Manager

• LP also works with other Vaya staff, members,relatives, caregivers/ natural supports, providers, and communitystakeholders. The Care Manager
• LP also utilizes licensed clinicalknowledge and skills to assess needs, inform care planningdevelopment, provide clinical consultation, and offerrecommendations for appropriate care. As further described below,essential job functions of the Care Manager
• LP includes, but maynot be limited to:

Utilization of and proficiency with Vaya’s CareManagement software platform/ administrative health record(“AHR”)Outreach and engagementCompliance with HIPAA (HealthInsurance Portability and Accountability) requirements, includingAuthorization for Release of Information (“ROI”)practicesPerforming Health Risk Assessments (HRA): a comprehensivebio-psycho-social assessment addressing social determinants ofhealth, mental health history and needs, physical health historyand needs, activities of daily living, access to resources, andother areas to ensure a whole person approach to careAdherence toMedication List and Continuity of Care processesParticipation ininterdisciplinary care team meetings, comprehensive care planning,and ongoing care managementTransitional Care ManagementDiversionfrom institutional placement This position is required to meet NC(North Carolina) Residency requirements as defined by the NCDepartment of Health and Human Services (“NCDHHS” or “Department”).This position is required to live in or near the counties served toeffectively deliver in-person contacts with members and their careteams.

ESSENTIAL JOB

FUNCTIONSClinical Assessment, Care Planning,and Interdisciplinary Care Team:

Ensures identification, assessment,and appropriate person-centered care planning for members. Linksmembers with appropriate and necessary formal/ informal servicesand supports across all health domains (i.e., medical, andbehavioral health home)Meets with members to conduct the HRA andgather information on their overall health, including behavioralhealth, developmental, medical, and social needs. Administers thePHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings basedon member’s needs. The Care Manager

• LP uses these screenings toprovide specific education and self-management strategies as wellas linkage to appropriate therapeutic supports.

The assessmentprocess includes reviewing and transcribing member’s currentmedication and entering information into Vaya’s Care Managementplatform, which triggers the creation of a multisource medicationlist that is shared back with prescribers to promote integratedcare.

Supports the care team in development of a person-centeredcare plan (“Care Plan”) to help define what is important to membersfor their health and prioritize goals that help them live the lifethey want in the community of their choice.

Ensure the Care Planincludes specific services to address mental health, substance use,medical and social needs as well as personal goalsEnsure the CarePlan includes all elements required by NCDHHSUse informationcollected in the assessment process to learn about member’s needsand assist in care planningEnsure members of the care team areinvolved in the assessment as indicated by the member/LRP and usesclinical skills to evaluate and incorporate other availableclinical information into the assessment as necessaryWork withmembers to identify barriers and help resolve dissatisfaction withservices or community-based interventionsUses clinical skills andexpertise to review clinical assessments conducted by providers toensure all areas of the member’s needs are addressed. Care Manager

• LP reviews for clinical accuracy and may provide consultation andtechnical support to providers as needed based onreviews.

Interprets and analyzes clinical assessments to drawclinical conclusions to support care management activities.

Engageswith provider clinical staff to determine clinical appropriatenessand course of action when assessments present a wide array oftreatment options and members present with complex needs.

Helpsmembers refine and formulate treatment goals, identifyinginterventions, measurements, and barriers to the goalsEnsures thatmember/legally responsible person (“LRP”) is/are informed ofavailable services, referral processes (e.g., requirements forspecific service), etc.

Provides information to member/LRP regardingtheir choice of service providers, ensuring objectivity in theprocessWorks in an integrated care team including, but not limitedto, an RN and pharmacist along with the member to address needs andgoals in the most effective way ensuring that member/LRP coulddecide who they want involved Supports and may facilitate care teammeetings where member Care Plan is discussed and reviewedSolicitsinput from the care team and monitor progressEnsures that theassessment, Care Plan, and other relevant information is providedto the care team Reviews assessments conducted by providers andconsult with clinical staff as needed to ensure all areas of themember’s needs are addressedProvide clinical assessment insituations where the member’s lack of clinical home or availablenetwork provider creates significant risk to member well-being(e.g., need for time sensitive placement/ discharge from inpatientsetting)Updates Care Plans and Care Management assessment at aminimum of annually or when there is a significant life change forthe memberSupports and assists with education and referral toprevention and population health management programs.

Works with themember/LRP and care team to ensure the development of a CareManagement Crisis Plan for the member that is tailored to theirneeds and desires, which is separate and complementary to thebehavioral health provider’s crisis planEnsures the crisis planincludes problem definition, physical/cognitive limitations, healthrisks/concerns, medication alerts, baseline functioning,signs/symptoms of crisis (triggers), de-escalation techniques.

Provides crisis intervention, coordination, and care management ifneeded while with members in the community.

Supports TransitionalCare Management responsibilities for members transitioning betweenlevels of careCoordinates Diversion efforts for members at risk ofrequiring care in an institutional settingConsults with caremanagement licensed professionals, care management supervisors, andother colleagues as needed to support effective and appropriatemember care.

Collaboration, Coordination, Documentation:

Utilizesadvanced knowledge in their work which requires use of theiradvanced degree and licensure to be able to participate andinitiate independent decisions with matters of significance anddrive positive clinical outcomes for Vaya members.

Executesindependent discretion and engages in business decisions for theVaya Care Management Department that support initiatives to promoteVaya’s integrated, whole-person care model for members.

Serves as acollaborative partner in identifying system barriers through workwith community stakeholders. Manages and facilitates Child/AdultHigh-Risk Team meetings in collaboration with DSS, DJJ, CCNC,school systems, and other community stakeholders as appropriate.

Works in partnership with other Vaya departments to identify andaddress gaps in services/ access to care within Vaya’scatchment.

Participates in cross-functional clinical andnon-clinical meetings and other projects as needed/ requested tosupport the department and organization.

Participates in routinemultidisciplinary huddles including RN, Pharmacist, M.D. to presentcomplex clinical case presentation and needs, providing support toother CMs (Care Manager) and receiving support and feedbackregarding CM interventions for clients’ medical, behavioral health,intellectual /developmental disability, medication, and otherneeds.

Participates in other high risk multidisciplinary complexcase staffing as needed to include Vaya CMO/ Deputy CMO,Utilization Management, Provider Network, and Care Managementleadership to address barriers, identify need for specializedservices to meet client needs within or outside the currentbehavioral health system.

Monitors provision of services toinformally measure quality of care delivered by providers andidentify potential non-compliance with standards.

Ensures the healthand safety of members receiving care management, recognize andreport critical incidents, and escalate concerns about health andsafety to care management leadership as needed.

Supportsproblem-solving and goal-oriented partnership with member/LRP,providers, and other stakeholders.

Promotes member satisfactionthrough ongoing communication and timely follow-up on anyconcerns/issues.

Supports and assists members/families on servicesand resources by using educational opportunities to presentinformation.

Verifies member’s continuing eligibility for Medicaid,and proactively responds to a member’s planned movement outsideVaya’s catchment area to ensure changes in their Medicaid county ofeligibility are addressed prior to any loss of service.

Proactivelyand timely creates and monitors documentation within the AHR toensure completeness, accuracy and follow through on care managementtasks.

Maintains electronic AHR compliance and quality according toVaya policy.

Ensures all clinical and non-clinical documentation(e.g. goals, plans, progress notes, etc.) meet all applicablefederal, state, and Vaya requirements, including requirementswithin Vaya’s contracts with NCDHHS.Participates in all requiredVaya/ Care Management trainings and maintains all required trainingproficiencies.

Participates in Vaya committees, workgroups, andother efforts that require clinical knowledge, as requested, andidentified. Other duties as assigned. KNOWLEDGE, SKILLS, &ABILITIESAbility to express ideas clearly/concisely and communicatein a highly effective mannerAbility to drive and sit for extendedperiods of time (including in rural areas)Exceptional interpersonalskills and ability to represent Vaya in a professionalmannerAbility to initiate and build relationships with people in anopen, friendly, and accepting mannerStrong attention to detail andsuperior organizational skillsAbility to make prompt independentdecisions based upon relevant facts.

Well-developed capabilities inproblem solving, negotiation, arbitration, and conflict resolution,including a high level of diplomacy and discretion to effectivelynegotiate and resolve issues with minimal assistance.

A result andsuccess-oriented mentality, conveying a sense of urgency anddriving issues to closureComfort with adapting and adjusting tomultiple demands, shifting priorities, ambiguity, and rapidchangeThorough knowledge of standard office practices, procedures,equipment, and techniques and intermediate to advanced proficiencyin Microsoft office products (Word, Excel, Power Point, Outlook,Teams, etc.), and Vaya systems, to include the care managementplatform, data analysis, and secondary researchMust be highlyskilled at shifting between macro and micro level planning,maintaining both the big picture, and seeing that the details arecovered.

Ability to use higher-level clinical training and licensureto perform clinical assessments, drive positive outcomes formembers, support care management colleagues, and offer clinicalassistance to providers.

Highly skilled at performing clinicalassessments of members and identifying member needs.

Extensiveunderstanding of the Diagnostic and Statistical Manual of MentalDisorders (current version) within their scope and haveconsiderable knowledge of the

MH/SU/IDD/TBI

service array providedthrough the network of Vaya providers. Experience and knowledge ofthe NC Medicaid program, NC Medicaid Transformation, TailoredPlans, state-funded services, and accreditation requirements arepreferred.

Ability to complete and maintain all trainings andproficiencies required by Vaya, however delivered, including butnot limited to the following:

BH I/DD Tailored Plan eligibility andservices Whole-person health and unmet resource needs (ACEs,trauma-informed care, cultural humility) Community integration(independent living skills; transition and diversion, supportivehousing, employment, etc.)Components of Health Home Care Management(Health Home overview, working in a multidisciplinary care team,etc.) Health promotion (common physical comorbidities,self-management, use of IT, care planning, ongoing coordination)Other care management skills (transitional care management,motivational interviewing, person-centered needs assessment andcare planning, etc.) Serving members with I/DD or TBI(understanding various I/DD and TBI diagnoses, HCBS, Accessingassistive technologies, etc.) Serving children (child-andfamily-centered teams, Understanding the “System of Care”approach)Serving pregnant and postpartum women with SUD or with SUDhistory Serving members with LTSS needs (Coordinating withsupported employment resources Job functions with higherconsequences of error may be identified, and proficiencydemonstrated and measured through job simulation exercisesadministered by the supervisor where a minimum threshold isrequired of the position.

QUALIFICATIONS & EDUCATIONREQUIREMENTS

Master’s degree in a field related to health,psychology, sociology, social work, nursing or another relevanthuman services area. For incumbents with a Master’s Degree in aHuman Services Area besides Nursing, one of the following requiredyears of experience:

Serving members with BH conditions:

Two (2)years of experience working directly with individuals with BHconditionsServing members with LTSS needsTwo (2) years of priorLong-tern Services and Supports and/or Home Community BasedServices coordination, care delivery monitoring and care managementexperience.

This experience may be concurrent with the two years ofexperience working directly with individuals with BH conditions, anI/DD, or a TBI, described above For incumbents with a Master’sDegree in Nursing, four years of full-time accumulated experiencein mental health with the population served is required. Experiencecan be before or after obtaining RN licensure.

• Must meet thecriteria of being a North Carolina Qualified Professional with thepopulation served in 10A

NCAC 27G .0104

Licensure/CertificationRequired:

Valid licensure required. Acceptable licenses areRegistered Nurse (RN), Licensed Clinical Social Worker (LCSW),Licensed Clinical Social Worker Associate (LCSWA), LicensedClinical Mental Health Counselor (LCMHC), Licensed Clinical MentalHealth Counselor Associate (LCMHCA), Licensed Clinical MentalHealth Counselor Supervisor (LCMHCS), Licensed PsychologicalAssociate (LPA), Health Services Professional PsychologicalAssociate (HSP-PA), Licensed Clinical Addiction Specialist (LCAS),Licensed Clinical Addiction Specialist Associate (LCASA), LicensedMarriage and Family Therapist (LMFT) or Licensed Marriage FamilyTherapist Associate (LMFTA).

• Due to the multi-disciplinary natureof the LME/MCO business, care managers must operate within theirscope of practice, and must engage and leverage other disciplinesoutside of their own training and credentials.

Preferred WorkExperience:

Experience working directly with individuals with I/DDor

TBI PHYSICAL REQUIREMENTS

Close visual acuity to perform activities suchas preparation and analysis of documents; viewing a computerterminal; and extensive reading. Physical activity in this positionincludes crouching, reaching, walking, talking, hearing andrepetitive motion of hands, wrists, and fingers. Sedentary workwith lifting requirements up to 10 pounds, sitting for extendedperiods of time. Mental concentration is required in all aspects ofwork. Ability to drive and sit for extended periods of time(including in rural areas)

RESIDENCY REQUIREMENT

The person in this position is required toreside in North Carolina or within 40 miles of the North Carolinaborder.

SALARY:

Depending on qualifications & experience of candidate. Thisposition is exempt and is not eligible for overtimecompensation.

DEADLINE FOR APPLICATION

Open Until Filled APPLY:

Vaya Health accepts online applications in our CareerCenter, please visit . Vaya Health is an equal opportunity employer.