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Acute Response Care Manager


- Fulltime   Acute Response Care Manager

Position Description Summary:

The Acute Response Care (ARCM) is responsible for proactive intervention and coordination of care to eligible members identified as Special Health Care Needs, Complex Care Management or High-Risk High-Cost populations that require complex care planning to alleviate inappropriate levels of care or care gaps through multidisciplinary team care planning, linkage and/or coordination of services across the MH/SU/IDD and other healthcare network(s) with existing or new care team members within the Acute Response CC’s professional scope. The ARCM is responsible for knowing and implementing organizational policies, Division and departmental specific guidelines.
Activities may include but not limited to the following:
  • In cooperation with Hospital Emergency Department or Inpatient Discharge planning teams, participate in developing transition plans, educating staff and members regarding network services and supports with consideration of medical necessity, funding eligibility and appropriateness of recommendations relative to person-centered, recovery principles and known best/appropriate practice.
  • Develop, coordinate and link emergency discharge services (up to and including residential placement based on medical necessity, funding, and service definitions or EPSDT for children/youth) for members who are inappropriately discharged from residential facilities (child or adult); coordination with FastTrack process; notifying Company Network of provider contractual concerns or through established process if quality of care or health and safety concerns;
  • Notification and update of assigned community-based Care Manager (CM) if member is currently assigned;
  • Transition to community-based CM post-discharge;
  • Participate in the development and implementation of best practice complex care strategies as identified by Company;
  • Provide proactive and clear supervision supported by data to ensure supervisors and teams are meeting departmental and organizational benchmarks; and
  • Collaborate with key stakeholders, network providers and non-network providers with particular attention to crisis, inpatient, 3-way bed contracts, NC START, etc.

This position works with staff, community partners and members in stakeholder catchment.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of the Company. The individual filling this position shall also sign a confidentiality statement as an employee of the Company.

Essential Duties and Responsibilities:
List in order of importance and Percentages equal to 100%



70% Acute Assessment, Care & Transition Planning & Interdisciplinary Care Team
  • Proactively ensures that members identified as eligible for Company CM that have treatment needs or require regular monitoring have Behavioral Health services and supports and linked, at a minimum, to primary care.
  • Ensures that the care plan includes a transition plan and ensure it is developed by care team or, if necessary, by the Acute Response CM to meet needs and to access care for the individual.
  • Convenes key providers and others to address needs of the individual, ideally in person or telephonically while member is still in facility.
  • Identifies gaps in services and supports, intervenes to ensure that the member receives appropriate care and can access that care.
  • Measures results of intervention and treatment, including reduction a high-risk events and inappropriate service utilization.
  • Ensures that services are coordinated across the Company system and with other systems, including primary care.
  • Provides clinical transition planning assistance to local hospitals, and coordinates with hospital liaisons when applicable, and tracks members discharged from state and local hospitals to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalizations.

Essential job functions of the ARCM include, but may not be limited to: 
  • CM Platform basics
  • Outreach & Engagement
  • Release of Information practices
  • Health Risk Assessment
  • Medication List and Continuity of Care process
  • Care Planning
  • Interdisciplinary Care Team and Ongoing Care Management


25% Collaboration:
This position will interface with key stakeholders and is responsible for understanding organizational goals, initiatives and requirements in order to effectively communicate and facilitate collaborative partnerships. This position is also expected to provide information from key stakeholder interactions to the appropriate departments and teams to improve the care continuum for members. Serve as a collaborative partner in identifying system barriers through work with community stakeholders, manages and facilitates care teams as appropriate. 

ARCM may participate in cross-functional clinical and non-clinical meetings and other projects to support the department and organization.  Participate in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CCM’s and receiving support and feedback regarding CCM interventions for clients’ medical, behavioral health, intellectual /developmental disability, medication, and other needs.  ARCM participates and ensures staff participate in other high risk multidisciplinary complex case staffing as needed to include Company Medical Director, Utilization Management, Provider Network, and Complex Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system.

5%
Other duties as assigned.

Supervisory Responsibilities:
N/A

Requirements:

N/A

Education and Experience:
A minimum of master’s degree in Human Service field (such as Psychology, Social Work, etc.) is required, along with at least two years of post-degree progressive experience providing similar services to the population served.  Additionally, valid licensure in profession (social work, counseling or psychology) is required.

Mental/Physical Demands: 

Person in this position is required to have close visual acuity to perform activities that include 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.

Knowledge, Skills and Abilities:
Employee will participate in and maintain Care Management and trainings and proficiencies as required.
A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.  This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts.  Problem-solving, negotiation, arbitration, and conflict resolution skills are essential to balance the needs of both co-workers and consumers/enrollees.  Must be highly skilled between macro and micro-level planning, maintaining a system and individual perspective.

The ARCM must exhibit an extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and have considerable knowledge of the MH/SU/IDD service array provided through the network of Vaya Health providers, Population Management, Disease Management, and Risk Management principles and strategies. Additional knowledge in Vaya Health Medicaid B and C waivers, working knowledge state plan Medicaid and Medicare services, state-funded initiatives and services, integrated care, and accreditation is essential.

The employee must be detail-oriented, able to organize multiple tasks and priorities and effectively manage projects from start to finish.  Work activities quickly change according to mandated changes and changing priorities within the department.  The employee must be able to change the focus of his/her activities to meet changing priorities.

Training, learning and proficiency are tracked through the Care Management Training Matrix and any other required means.  Training may be delivered in a variety of methods and forums.  ARCM must understand the following areas, in addition to other required trainings:
  • BH I/DD Tailored Plan eligibility and services
  • Whole-person health and unmet resource needs (ACEs, 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 SUD or with SUD history
  • Serving members with LTSS needs (Coordinating with supported employment resources

ARCM should be proficient in the aforementioned essential job functions.  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. 
In addition, ARCM must have a thorough knowledge of standard office practices, procedures, equipment, and techniques and have intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.)

Licensure:
Valid licensure in profession (social work, counseling or psychology) is required.

Certifications
N/A


Driving on Company Business:
This position requires driving a personal vehicle in accordance with 2995 Expense Reimbursement policy and 2498 Driving on Company Business.

Decision Making/Consequences of Error:
Decisions result in members either receiving or not receiving appropriate services or appropriate referrals for higher-level assistance as needed.