Tailored Care Case Manager Comprehensive Interventions, Inc. - 4.3 Greenville, NC Job Details Full-time $23.96 - $28.85 an hour 1 day ago Benefits Health insurance Dental insurance Vision insurance Professional development assistance Life insurance Qualifications Record keeping Addiction counseling Patients with traumatic brain injuries Patients with cognitive disabilities Maintaining patient confidentiality Group therapy Experience working with individuals with cognitive disabilities Clinical case management Medicaid health insurance Care planning in social services Driver's License Cultural competency Bachelor's degree Intellectual disabilities support Mental health counseling Working with families Working with individuals from diverse cultural backgrounds Working with individuals with mental health conditions Medicaid regulations Medicaid Social work care coordination Managing patients as a clinical case manager Individual counseling

Full Job Description Tailored Care Case Manager Job Description Job Title:

Tailored Care Case Manager Work Type:

Hybrid with community-based travel

Employment Status:

Full Time Position Summary The Tailored Care Case Manager provides comprehensive, person-centered care management to eligible Medicaid members with behavioral health conditions, intellectual or developmental disabilities, traumatic brain injuries, long-term services and supports needs, or other complex health conditions. The Case Manager serves as the primary point of contact for assigned members and coordinates physical health, behavioral health, pharmacy, social services, long-term services and supports, and unmet health-related resource needs. Services are provided in members' homes, community settings, provider offices, and through approved telehealth or telephone methods. Essential Duties and ResponsibilitiesMember Engagement Contact newly assigned members and explain the Tailored Care Management program. Obtain and document the member's consent to participate. Respect the member's right to select a provider, participate in care planning, or opt out of Tailored Care Management. Use person-centered engagement strategies based on the member's preferences, risks, communication needs, culture, and accessibility needs. Document all outreach attempts, successful contacts, and barriers to engagement. Maintain frequent member-facing contact based on each member's needs and level of risk. Complete in-person contacts in members' homes, communities, provider offices, or other appropriate settings. Comprehensive Assessment Complete the required Care Management Comprehensive Assessment according to NC Medicaid, Tailored Plan, LME/MCO, and agency requirements. Make best efforts to complete the initial assessment within 90 days of the member's consent to participate. Complete and document strategic follow-up attempts when the member cannot initially be reached. Assess the member's physical health, behavioral health, developmental, functional, pharmacy, social, housing, employment, transportation, safety, and accessibility needs. Identify urgent needs and begin coordinating appropriate services before completion of the full assessment when necessary. Complete an interim care plan when urgent needs require immediate intervention. Reassess members annually and following significant changes, triggering events, or requests from the member or legally responsible person. Care Planning Develop an individualized Care Plan or Individual Support Plan based on assessment findings, member preferences, identified strengths, needs, and goals. Make best efforts to complete the initial Care Plan or ISP within 30 days after completing the comprehensive assessment. Include the member, legally responsible person, family members, natural supports, and appropriate providers in the care-planning process. Develop measurable goals, interventions, responsible parties, target dates, and methods for monitoring progress. Review and update Care Plans and ISPs following reassessments, triggering events, changes in condition, transitions, or requests from the member. Provide members with understandable information and alternate formats when needed. Share assessments, Care Plans, and ISPs with authorized care team members according to required timeframes, consent requirements, and applicable law. Care Coordination Comprehensive care management Care coordination Health promotion Comprehensive transitional care Individual and family support Referral to community and social support services Coordinate physical health, behavioral health, I/DD, TBI, pharmacy, dental, vision, and long-term services and supports. Assist members with scheduling and attending appointments. Coordinate communication among primary care providers, behavioral health providers, specialists, hospitals, pharmacies, social service agencies, and community resources. Monitor referrals and follow up to determine whether the member received the requested service. Help members address barriers involving transportation, housing, food, employment, education, utilities, safety, and other health-related resource needs. Participate in multidisciplinary care-team meetings and Child and Family Team meetings when applicable. Clearly distinguish TCM activities from case-management activities included in other Medicaid services to prevent duplication. Transitional Care Monitor admission, discharge, and transfer information available through agency and health-plan systems. Contact members following hospital, emergency department, facility, or other care-setting transitions. Complete required follow-up within 48 hours after discharge unless a shorter timeframe applies. Coordinate medication reconciliation, follow-up appointments, medical equipment, transportation, home supports, and other post-discharge needs. Complete or update the comprehensive assessment following qualifying transitions. Update the Care Plan or ISP based on the member's post-discharge needs. Communicate transition information to authorized care-team members. Documentation and Billing Support Complete accurate, timely, objective, and person-centered documentation. Document the member's need, intervention provided, participation, response, outcome, barriers, follow-up plan, responsible party, and due date. Connect each intervention to the member's assessment, Care Plan, ISP, or identified need. Ensure member-facing contacts address one or more core Health Home services. Document contacts in the agency's care-management information system within required timeframes. Submit required reports, encounter information, assessments, plans, and supporting documentation. Review assigned members each month to identify individuals at risk of receiving no qualifying contact. Correct documentation deficiencies within the timeframe established by the supervisor. Care Manager Extender Oversight When assigned an extender, the Tailored Care Case Manager will: Direct the extender's permitted care-management activities. Assign tasks that remain within the extender's approved scope. Review extender documentation and follow-up activities. Maintain responsibility for assessment, care planning, clinical judgment, and overall coordination. Communicate regularly with the extender and supervising care manager. Ensure that delegated activities remain coordinated with the member's Care Plan or ISP. Crisis and Safety Responsibilities Identify and respond to urgent health, behavioral health, safety, abuse, neglect, exploitation, housing, and medication concerns. Follow agency procedures for crisis response, mandated reporting, incident reporting, and supervisory notification. Assist members with developing and understanding crisis, safety, emergency, and disaster plans. Immediately notify the supervisor of situations involving serious member risk, inability to access essential services, or threats to continuity of care. Contact emergency services when an immediate threat to health or safety exists. Supervision and Training Participate in individual and group supervision. Present complex cases, barriers, transitions, overdue requirements, and safety concerns during supervision. Complete the Tailored Plan or

LME/MCO TCM

training curriculum and required annual refresher training. Complete training on in-reach, transition services, person-centered planning, cultural competency, trauma-informed care, HIPAA, fraud and abuse prevention, and applicable special populations. Maintain required licenses, certifications, registrations, and training credentials. Participate in quality reviews, record audits, coaching, and corrective action activities. Minimum Qualifications Meet North Carolina's definition of a Qualified Professional under 10A

NCAC 27G .0104.

Possess a bachelor's degree from an accredited college or university in social work, psychology, counseling, human services, sociology, special education, nursing, or another qualifying field. Have the required professional experience working with individuals with behavioral health conditions, substance use disorders, I/DD, TBI, or other complex needs. Care Managers serving members with LTSS needs must have at least two years of experience with LTSS or HCBS coordination, care-delivery monitoring, or care management. This experience may run concurrently with experience used to meet Qualified Professional requirements. Demonstrate knowledge of person-centered planning, Medicaid services, community resources, care coordination, and clinical documentation. Possess a valid North Carolina driver's license, reliable transportation, and automobile insurance. Successfully complete required background checks, healthcare registry checks, drug screening, and other pre-employment requirements. Preferred Qualifications Previous Tailored Care Management, case management, care coordination, or community-based behavioral health experience. Experience serving individuals with serious mental illness, serious emotional disturbance, substance use disorders, I/DD, TBI, or long-term services and supports needs. Knowledge of NC Medicaid Managed Care, Tailored Plans, LME/MCOs, Innovations Waiver, TBI Waiver, 1915(i) services, and Transitions to Community Living. Experience using electronic health records, care-management platforms, claims information, admission-discharge-transfer notifications, and Microsoft Office. Familiarity with motivational interviewing, trauma-informed care, System of Care, and Child and Family Team practices. Required Knowledge Skills and Abilities Strong assessment, engagement, care-planning, and care-coordination skills. Ability to manage a community-based caseload and prioritize members according to current needs and risk. Ability to meet deadlines and maintain organized records. Strong verbal and written communication skills. Ability to work independently while remaining responsive to supervision. Ability to collaborate with members, families, providers, hospitals, schools, DSS, legal systems, and community organizations. Ability to maintain professional boundaries and protect confidential information. Ability to respond calmly and appropriately to urgent or crisis situations. Cultural awareness and respect for individual differences, member preferences, and lived experiences. Work Schedule The normal work schedule is Monday through Friday during regular business hours. Evening, weekend, and after-hours flexibility may be required based on member needs, transitions, emergencies, scheduled meetings, and program coverage. Travel and Work Environment This is a hybrid, community-based position requiring regular travel throughout the assigned North Carolina service area. Duties may be performed in members' homes, hospitals, schools, provider offices, community settings, and other locations appropriate to the member's needs. The employee must be able to operate a computer, communicate by telephone and approved virtual platforms, maintain records, travel independently, and work in varied community environments.

Pay:

$23.96 - $28.85 per hour

Benefits:

Dental insurance Health insurance Life insurance Professional development assistance Vision insurance

Work Location:

Hybrid remote in Greenville, NC 27858