1915(i) Care Coordination Manager (Haywood/Buncombe Counties)

Company: Vaya Health
Location: Clyde
Posted on: April 16, 2024

Job Description:

LOCATION: Remote - must live in or near Haywood or Buncombe County, NC.

GENERAL STATEMENT OF JOBThe 1915(i) Care Coordination Manager is responsible for providing day to day coaching to assigned 1915i Care Coordination staff to ensure responsibilities are carried out effectively and accurately. The 1915(i) Care Coordination Manager is also responsible for knowing and implementing 1915 (i) Waiver Care Coordination requirements.
The 1915(i) Care Coordination Manager is responsible for providing oversight of the 1915 (i) Care Coordination team's proactive intervention and coordination of care to eligible Vaya Health members and coordination of care to eligible members identified as transitioning from B3 to 1915i Waiver services or newly identified members needing 1915i services. The 1915(i) Care Coordination Manager is responsible for determining eligibility for 1915i Care Coordination and assigning to and managing staff caseloads. The 1915(i) Care Coordination Manager may work with staff, and members, if necessary, in the communities and is also responsible for overseeing, and when necessary, providing care coordination activities and monitoring to individuals who have been deemed eligible for 1915i services by North Carolina Department of Health and Human Services (DHHS). The 1915(i) Care Coordination Manager provides oversight for all following activities conducted by the Care Coordinator. Care Coordinator works with the member and care team to alleviate inappropriate levels of care or care gaps, coordinate multidisciplinary team care planning, linkage and/or coordination of services across the 1915i service array and other healthcare network(s) including 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. Care Coordinator support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members' home communities. The Care Coordinator also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. As further described below, essential job functions of the Care Coordinator include, but may not be limited to:

• Utilization of and proficiency with Vaya's Care Management software platform/ administrative health record ("AHR")
• Outreach and engagement
• Compliance with HIPAA requirements, including Authorization for Release of Information ("ROI") practices
• Performing NC Medicaid 1915i Assessment tool to gather information on the member's relevant diagnosis, activities of daily living, instrumental activities of daily living, social and work-related needs, cognitive and behavioral needs, and services the member is interested in receiving
• Adherence to Medication List and Continuity of Care processes
• Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management
• Transitional Care Management
• Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services ("NCDHHS" or "Department"). ESSENTIAL JOB FUNCTIONSManagement:
  • Effectively implements organizational priorities, quality initiatives and programs through the 1915i Care Coordination team.
  • Provides administrative direction and ensures clinical guidance to their team(s) regarding member care and community collaboration activities.
  • Proficient in 1915(i) Care Coordination team workflows and use of technology used by team to complete daily work.
  • Ensures that 1915i Care Coordinators have knowledge of duties and that they are carried out effectively.
  • Provides supervision to 1915i Care Coordination team by observing and monitoring work and documentation to ensure activities are carried out within the Vaya catchment area in an effective manner. Supervision includes in person observation, documentation review and ongoing coaching.
  • Conducts performance reviews as required and conduct employee trainings.
  • Works with employee to mediate dissatisfaction within the community.
  • Ensures identification, assessment and appropriate Person-Centered Care Planning and Service Planning for members who have been deemed eligible for 1915i services by DHHS or DHHS vendor.
  • Professionally represents Vaya Health, as well as their department/Division, at designated community stakeholder, provider or Department of Health and Human Service related meetings.
  • Oversees 1915 (i) Care Coordinators to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya's contracts with NCDHHS.
  • Participates in and ensures all teams participate in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Assessment, Care Planning, Service Planning and Interdisciplinary Care Team:1915(i) Care Coordination Manager may provide direct 1915i Care Coordination activities in situations that require such as staff shortages, staff on leave, or an elevated need for services or oversight. Those activities include:
    • Ensures identification, assessment, and appropriate person-centered care planning for members.
    • Meets with members to complete a standardized NC Medicaid 1915i Assessment
    • Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home)
    • Supports the care team in development of a person-centered care plan ("Care Plan") to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice.
      • Ensure the Care Plan includes specific services, including 1915(i) services to address mental health, substance use or I/DD, medical and social needs as well as personal goals
      • Ensure the Care Plan includes all elements required by NCDHHS
      • Use information collected in the assessment process to learn about member's needs and assist in care planning
      • Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary
      • Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions
      • Reviews clinical assessments conducted by providers and partners with licensed staff for clinical consultation as needed to ensure all areas of the member's needs are addressed. Help members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals
      • Ensures that member/legally responsible person ("LRP") is/are informed of available services, referral processes (e.g., requirements for specific service), etc.
      • Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process
      • Works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved
      • Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed
      • Solicits input from the care team and monitors progress
      • Ensures that the assessment, Care Plan, and other relevant information is provided to the care team
      • Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care. Support Monitoring/Coordination, Documentation and Fiscal Accountability:1915(i) Care Coordination Manager may provide direct 1915i Care Coordination activities in situations that require such as staff shortages, staff on leave, or an elevated need for services or oversight. Those activities include:
        • Serves as a collaborative partner in identifying system barriers through work with community stakeholders.
        • Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya's catchment.
        • Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization.
        • Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients' medical, behavioral health, intellectual /developmental disability, medication, and other needs.
        • Works with 1915 (i) Care Coordination manager in participating in high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system.
        • Ensure that services are monitored (including direct observation of service delivery) in all settings at required frequency and for compliance with standards
        • Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards.
        • Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed.
        • Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders.
        • Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues.
        • Supports and assists members/families on services and resources by using educational opportunities to present information.
        • Make announced/unannounced monitoring visits, including nights/weekends as applicable.
        • Promote satisfaction through ongoing communication and timely follow-up on any concerns/issues
        • Monitor services to ensure that they are delivered as outlined in individualized service plan and address any deviations in service
        • Verifies member's continuing eligibility for Medicaid, and proactively responds to a member's planned movement outside Vaya's catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service. Alerts supervisor and other appropriate Vaya staff if there is a change in member Medicaid eligibility/status.
        • Maintain electronic health record compliance/quality according to Vaya policy
        • Proactively monitor own documentation to ensure that issues/errors are resolved as quickly as possible
        • Ensure accurate/timely submission of Service Authorization Requests (SARS) for all Vaya funded services/supports
        • Proactively monitors own documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks.
        • Works with 1915 (i) Care Coordination Manager to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya's contracts with NCDHHS.
        • Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Other duties as assigned. KNOWLEDGE, SKILL & ABILITIES:
          • Ability to express ideas clearly/concisely and communicate in a highly effective manner
          • Ability to drive and sit for extended periods of time (including in rural areas)
            • Effective interpersonal skills and ability to represent Vaya in a professional manner
            • Ability to initiate and build relationships with people in an open, friendly, and accepting manner
            • Attention to detail and satisfactory organizational skills
            • Ability to make prompt independent decisions based upon relevant facts.
            • A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure
            • Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change
            • Thorough knowledge of standard office practices, procedures, equipment, and techniques and intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research
            • Understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers.
            • Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred.
            • Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following:
              • BH I/DD Tailored Plan eligibility and services
              • Whole-person health and unmet resource needs (Adverse Childhood Experiences, Trauma, cultural humility)
              • Community integration (Independent living skills; transition and diversion, supportive housing, 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 and care planning, etc)
              • Serving members with I/DD or TBI (Understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc)
              • Serving children (Child and family centered teams, understanding of the "System of Care" approach)
              • Serving pregnant and postpartum women with Substance Use Disorder (SUD) or with SUD history
              • Serving members with LTSS needs (Coordinating with supported employment resources)
              • Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position. QUALIFICATIONS & EDUCATION REQUIREMENTSMaster's Degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area is required. Three (3) years of experience providing care management, case management, or care coordination to the population being served Licensure/Certification Required:Valid Licensure by the licensures governing board in North Carolina is required. Must hold a license, provisional license, certificate, registration or permit issued by the governing board regulating a human service profession (examples include LCSW, LMFT, LCAS, LCMHC, LPA, RN, OTR/L, PT). PHYSICAL REQUIREMENTS:
                • Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
                • Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
                • Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
                • Mental concentration is required in all aspects of work.
                • Ability to drive and sit for extended periods of time (including in rural areas). RESIDENCY REQUIREMENT:This position is required to reside in North Carolina or within 40 miles of the North Carolina border.
                  SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit Vaya Health is an equal opportunity employer.
                  

Keywords: Vaya Health, Asheville , 1915(i) Care Coordination Manager (Haywood/Buncombe Counties), Executive , Clyde, North Carolina