1915(i) Care Coordination Manager (Rowan County)
Company: Vaya Health
Location: Asheville
Posted on: April 24, 2024
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Job Description:
LOCATION: Remote - must live in or near Rowan 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
engagementCompliance with HIPAA requirements, including
Authorization for Release of Information ("ROI")
practicesPerforming 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 processesParticipation in interdisciplinary
care team meetings, comprehensive care planning, and ongoing care
managementTransitional Care ManagementDiversion 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 goalsEnsure
the Care Plan includes all elements required by NCDHHSUse
information collected in the assessment process to learn about
member's needs and assist in care planningEnsure 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 necessaryWork with
members to identify barriers and help resolve dissatisfaction with
services or community-based interventionsReviews 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 goalsEnsures 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 processWorks 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 reviewedSolicits
input from the care team and monitors progressEnsures 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 standardsMonitors
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/issuesMonitor services to ensure that they are delivered
as outlined in individualized service plan and address any
deviations in serviceVerifies 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
policyProactively monitor own documentation to ensure that
issues/errors are resolved as quickly as possibleEnsure
accurate/timely submission of Service Authorization Requests (SARS)
for all Vaya funded services/supportsProactively 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
mannerAbility to drive and sit for extended periods of time
(including in rural areas)Effective interpersonal skills and
ability to represent Vaya in a professional mannerAbility to
initiate and build relationships with people in an open, friendly,
and accepting mannerAttention to detail and satisfactory
organizational skillsAbility to make prompt independent decisions
based upon relevant facts.A result and success-oriented mentality,
conveying a sense of urgency and driving issues to closureComfort
with adapting and adjusting to multiple demands, shifting
priorities, ambiguity, and rapid changeThorough 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 researchUnderstanding 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 servicesWhole-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 historyServing
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 (Rowan County), Executive , Asheville, North Carolina
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