MHSU Care Manager - LP (Granville County)
Company: Vaya Health
Location: Asheville
Posted on: April 24, 2024
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Job Description:
LOCATION: Remote - must live in or near Granville County, NC.
GENERAL STATEMENT OF JOBThe Mental Health/Substance Use ("MHSU")
Care Manager Licensed Professional ("MHSU Care Manager, LP") is
responsible for providing proactive intervention and coordination
of care to eligible Vaya Health members and recipients ("members")
to ensure that these individuals receive appropriate assessment and
services. The MHSU Care Manager, LP works with the member and care
team to identify and alleviate inappropriate levels of care or care
gaps through assessment, multidisciplinary team care planning,
linkage and/or coordination of 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. MHSU Care Manager, LP supports and may provide
clinical 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 MHSU
Care Manager, LP also works with other Vaya staff, members,
relatives, caregivers/ natural supports, providers, and community
stakeholders. The MHSU Care Manager, LP also utilizes licensed
clinical knowledge and skills to assess needs, inform care planning
development, provide clinical consultation, and offer
recommendations for appropriate care. As further described below,
essential job functions of the MHSU Care Manager, LP includes, 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 (Health
Insurance Portability and Accountability) requirements, including
Authorization for Release of Information ("ROI")
practicesPerforming Health Risk Assessments (HRA): a comprehensive
bio-psycho-social assessment addressing social determinants of
health, mental health history and needs, physical health history
and needs, activities of daily living, access to resources, and
other areas to ensure a whole person approach to careAdherence to
Medication List and Continuity of Care processesParticipation in
interdisciplinary care team meetings, comprehensive care planning,
and ongoing care managementTransitional Care Management, Diversion
from institutional placement This position is required to meet NC
(North Carolina) Residency requirements as defined by the NC
Department of Health and Human Services ("NCDHHS" or "Department").
ESSENTIAL JOB FUNCTIONSClinical Assessment, Care Planning, and
Interdisciplinary Care Team:Ensures identification, assessment, and
appropriate person-centered care planning for members. Links
members with appropriate and necessary formal/ informal services
and supports across all health domains (i.e., medical, and
behavioral health home)Meets with members to conduct the HRA and
gather information on their overall health, including behavioral
health, developmental, medical, and social needs. Administers the
PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings based
on member's needs. The MHSU Care Manager, LP uses these screenings
to provide specific education and self-management strategies as
well as linkage to appropriate therapeutic supports.The assessment
process includes reviewing and transcribing member's current
medication and entering information into Vaya's Care Management
platform, which triggers the creation of a multisource medication
list that is shared back with prescribers to promote integrated
care.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 to address mental health, substance use,
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 uses
clinical skills to evaluate and incorporate other available
clinical information into the assessment as necessaryWork with
members to identify barriers and help resolve dissatisfaction with
services or community-based interventionsUses clinical skills and
expertise to review clinical assessments conducted by providers to
ensure all areas of the member's needs are addressed. MHSU Care
Manager, LP reviews for clinical accuracy and may provide
consultation and technical support to providers as needed based on
reviews.Interprets and analyzes clinical assessments to draw
clinical conclusions to support care management activities.Engages
with provider clinical staff to determine clinical appropriateness
and course of action when assessments present a wide array of
treatment options and members present with complex needs.Helps
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 and pharmacist along with the member to address needs and
goals in the most effective way ensuring that member/LRP could
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 monitor progressEnsures that the
assessment, Care Plan, and other relevant information is provided
to the care team Reviews assessments conducted by providers and
consult with clinical staff as needed to ensure all areas of the
member's needs are addressedProvide clinical assessment in
situations where the member's lack of clinical home or available
network provider creates significant risk to member well-being
(e.g., need for time sensitive placement/ discharge from inpatient
setting)Updates Care Plans and Care Management assessment at a
minimum of annually or when there is a significant life change for
the memberSupports and assists with education and referral to
prevention and population health management programs.Works with the
member/LRP and care team to ensure the development of a Care
Management Crisis Plan for the member that is tailored to their
needs and desires, which is separate and complementary to the
behavioral health provider's crisis planEnsures the crisis plan
includes problem definition, physical/cognitive limitations, health
risks/concerns, medication alerts, baseline functioning,
signs/symptoms of crisis (triggers), de-escalation techniques.
Provides crisis intervention, coordination, and care management if
needed while with members in the community.Supports Transitional
Care Management responsibilities for members transitioning between
levels of careCoordinates Diversion efforts for members at risk of
requiring care in an institutional settingConsults with care
management licensed professionals, care management supervisors, and
other colleagues as needed to support effective and appropriate
member care. Collaboration, Coordination, Documentation:Utilizes
advanced knowledge in their work which requires use of their
advanced degree and licensure to be able to participate and
initiate independent decisions with matters of significance and
drive positive clinical outcomes for Vaya members.Executes
independent discretion and engages in business decisions for the
Vaya Care Management Department that support initiatives to promote
Vaya's integrated, whole-person care model for members.Serves as a
collaborative partner in identifying system barriers through work
with community stakeholders. Manages and facilitates Child/Adult
High-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 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.Participates in other 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.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.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.Proactively
and timely creates and monitors documentation within the AHR to
ensure completeness, accuracy and follow through on care management
tasks.Maintains electronic AHR compliance and quality according to
Vaya policy.Ensures 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.Participates in Vaya committees, workgroups, and
other efforts that require clinical knowledge, as requested, and
identified. 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)Exceptional
interpersonal skills and ability to represent Vaya in a
professional mannerAbility to initiate and build relationships with
people in an open, friendly, and accepting mannerStrong attention
to detail and superior organizational skillsAbility to make prompt
independent decisions based upon relevant facts.Well-developed
capabilities in problem solving, negotiation, arbitration, and
conflict resolution, including a high level of diplomacy and
discretion to effectively negotiate and resolve issues with minimal
assistance.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 researchMust be
highly skilled at shifting between macro and micro level planning,
maintaining both the big picture, and seeing that the details are
covered.Ability to use higher-level clinical training and licensure
to perform clinical assessments, drive positive outcomes for
members, support care management colleagues, and offer clinical
assistance to providers.Highly skilled at performing clinical
assessments of members and identifying member needs.Extensive
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 (ACEs,
trauma-informed care, 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 the "System of Care"
approach)Serving pregnant and postpartum women with 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. For incumbents with a Master's Degree in a
Human Services Area besides Nursing, one of the following required
years of experience:Serving members with BH conditions:Two (2)
years of experience working directly with individuals with BH
conditionsServing members with LTSS needsTwo (2) years of prior
Long-tern Services and Supports and/or Home Community Based
Services coordination, care delivery monitoring and care management
experience.This experience may be concurrent with the two years of
experience working directly with individuals with BH conditions, an
I/DD, or a TBI, described above For incumbents with a Master's
Degree in Nursing, four years of full-time accumulated experience
in mental health with the population served is required. Experience
can be before or after obtaining RN licensure. *Must meet the
criteria of being a North Carolina Qualified Professional with the
population served in 10A NCAC 27G .0104 Licensure/Certification
Required:Valid licensure required. Acceptable licenses are
Registered Nurse (RN), Licensed Clinical Social Worker (LCSW),
Licensed Clinical Social Worker Associate (LCSWA), Licensed
Clinical Mental Health Counselor (LCMHC), Licensed Clinical Mental
Health Counselor Associate (LCMHCA), Licensed Clinical Mental
Health Counselor Supervisor (LCMHCS), Licensed Psychological
Associate (LPA), Health Services Professional Psychological
Associate (HSP-PA), Licensed Clinical Addiction Specialist (LCAS),
Licensed Clinical Addiction Specialist Associate (LCASA), Licensed
Marriage and Family Therapist (LMFT) or Licensed Marriage Family
Therapist Associate (LMFTA). *Due to the multi-disciplinary nature
of the LME/MCO business, care managers must operate within their
scope of practice, and must engage and leverage other disciplines
outside of their own training and credentials. 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 , MHSU Care Manager - LP (Granville County), Executive , Asheville, North Carolina
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