MHSU Care Management Manager
GENERAL STATEMENT OF JOB:
Mental Health/Substance Use(MHSU) Care Management (CM)Manager is responsible for providing day to day coaching to assigned MHSU Care Management staff to ensure responsibilities are carried out effectively and accurately. MHSU Care Management Manager is also responsible for knowing and implementing NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services standards and organizational policies.Â
MHSU Care Management Manager is responsible for providing oversight of the MHSU Care Management team through providing proactive intervention and coordination of care to eligible members identified as Special Health Care Needs, Complex Care Management or High-Risk High Cost populations to ensure that these individuals receive appropriate assessment and services. The MHSU Manager is responsible for determining eligibility for care management and assigning to and managing staff caseloads. The MHSU Care Management Manager may work with staff, and members if necessary, in the communities. Â MHSU Care Management Manager works with the assigned Care Manager, 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 MH/SU/I/DD and other healthcare network(s). MHSU Care Management Manager works with the assigned Care Manager who may also provide administrative transition planning assistance to local hospitals and other institutions. This is a mobile position with work done in a variety of locations [i.e. memberâ€™s home community, provider office(s)]. MHSU Care Management Manager also works with other staff, members and family members, providers as well as community stakeholders. Essential job functions 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
*Must reside in North Carolina
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. The individual filling this position shall also sign a confidentiality statement as an employee.
ESSENTIAL JOB FUNCTIONS:
- Effectively implement organizational priorities, quality initiatives and programs through the MHSU CM Team.Â
- Provide administrative direction and clinical guidance to their team(s) regarding member care and community collaboration activities.Â
- Proficient in team workflows and use of technology used by MHSU CMs to complete routine work.Â
- Represent Vaya Health, as well as their department/Division, at designated community stakeholder, provider or Department of Health and Human Service related meetings.Â
- Provide supervision to MHSU Care Manager team by observing and monitoring paperwork/documentation to ensure that the following Care Management activities are carried out within the Vaya catchment area in an effective manner. Activities include but are not limited to; employee coaching to ensure continuous improvement of performance in meeting the needs of the members and communities. Coaching includes both in person observation as well as review.Â
- Conduct performance reviews as required and conduct employee trainings and job simulation exercises to include but not limited to policies and procedures and service definitions.Â
- Work with employee to mediate dissatisfactionÂ withinÂ theÂ community.
- Ensure that MHSU Care Managers have knowledge of duties described below and carry out these duties within their respective teams by providing direct supervision.Â
- May provide direct CM activities in situations that require such as staff shortages or an elevated need for services.
- Ensures identification, assessment and appropriate Person-Centered Care Planning for members identified as having Special Health Care Needs or as High-Risk High Cost members (as supported by state funds) or other complex care management populations in order to link to determine appropriate formal and informal services and supports including a medical and behavioral health home and monitor services.
Clinical Assessment, Care Planning & Interdisciplinary Care Team:
- MHSU CM Managers will ensure that MHSU Care Managers have knowledge of duties described below and carry out these duties by providing direct supervision, case review and reviewing operational reports:
- MHSU CM Managers ensure MHSU CM meet with members to conduct a comprehensive bio-psycho-social assessment in order to gather information on their overall health, including behavioral health, developmental, medical and social needs. The Health Risk Assessment (HRA) encompasses a comprehensive assessment addressing social determinants of health, mental health history and needs, physical health history and needs, intellectual/developmental disabilities, activities of daily living, access to resources, and other areas to ensure a whole person approach to care.Â
- MHSU Care Manager may administerÂ the PHQ-9, GAD, CRAFT, ACES, LOCUS/ CALOCUS, and other assessments based on memberâ€™s clinicalÂ needs. Scores are calculated and reviewed allowing MHSU CM to provide specific education and self-Â management strategies as well as linkage to appropriate therapeutic support(s).Â The assessment process includesÂ reviewing and transcribing memberâ€™s current medication and entering information into Vayaâ€™s Care ManagementÂ platformÂ toÂ trigger the continuityÂ ofÂ care processÂ whichÂ resultsÂ inÂ theÂ creationÂ ofÂ aÂ multisourceÂ medicationÂ listÂ thatÂ isÂ shared back with prescribersÂ to promoteÂ integrated care.
- MHSUÂ CMÂ ManagerÂ ensuresÂ MHSUÂ CM usesÂ the assessmentÂ toÂ learnÂ aboutÂ theÂ member'sÂ needsÂ toÂ assist the member and their team in planning for their care, prioritizing goals that to help them live the life theyÂ want in the community of their choice.Â MHSU Care Managers ensure members of the care team are involved inÂ the assessment as indicated by the member and that other available clinical information is reviewed andÂ incorporated into the assessment as necessary. Care Plans and CM assessment are updated at a minimum ofÂ annuallyÂ orÂ whenÂ thereÂ isÂ aÂ significantÂ life changeÂ forÂ the member.
- MHSU CM Managers ensure MHSU CM use the assessment to create a person-centered care plan for members to help define what is important to members for their health. Care Plans are created based on information collected in the assessment process. MHSU CM assist members in refining and formulating treatment goals, identifying interventions, measurements and barriers to the goals.Â
- MHSU CM Managers ensures MHSU CM works 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. MHSU CM and member solicit input from the care team and monitor progress.Â
- MHSU CM Managers ensure Care Plans completed by MHSU CM include specific services to address mental health, substanceÂ use or intellectual/developmental disability,Â medicalÂ and socialÂ needsÂ as wellÂ asÂ personalÂ goals.
- MHSU CM Managers ensure MHSU CM allows members/guardians to have the opportunity to decide who they want at the care team meeting, coordinates, and may facilitate the team meeting where member Care Plan is discussed and reviewed.Â
- MHSU CM Managers ensure Â MHSU CM provide the assessment, care plan and other relevant information to the care team as indicated in Vaya policy and necessary Care Plan elements are included in accordance with 2335.
- MHSU CM Managers ensure Â MHSU CM complete Crisis planning with member and care team. MHSU Care Managers create a care management crisis plan which is a separate but complimentary to the behavioral health providerâ€™s crisis plan. MHSU CM collaborates with members to develop a Crisis Plan that is tailored to their needs and desires. The MHSU Care Manager ensures the Â Â crisis plan includes problem definition, physical/cognitive limitations, health risks/concerns, medication alerts, baseline functioning, signs/symptoms of crisis (triggers), de-escalation techniques. Provide crisis intervention, coordination, and care management if needed while with members in the community.
MHSU Care Management Manager will ensure MHSU Care Managers have knowledge of duties described below and carry out these duties byÂ providing direct supervision:
- May provide services in situations that require such as staff shortages or an elevated need for services. Serves as a collaborative partner in identifying system barriers through work with community stakeholders.Â
- Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate.Â
- Works in partnership with other departments to address identified needs within the catchment. MHSU CM may participate in cross-functional clinical and non-clinical meetings and other projects to support the department and organization.Â
- Participate inÂ routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentationÂ and needs, providing support to other CMâ€™s and receiving support and feedback regarding CM interventionsÂ forÂ clientsâ€™Â medical,Â behavioralÂ health,Â intellectualÂ /developmentalÂ disability,Â medication,Â andÂ otherÂ needs.
- MHSU CM participates in other high risk multidisciplinary complex case staffings as needed to includeÂ Medical Director, 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.
QUALIFICATIONS & CREDENTIALING REQUIREMENTS:Â
A Master's Degree in A field related to health, psychology, sociology, social work, nursing, or another relevant human services area or licensure as an RN with three (3) years of experience providing care management, case management, or care coordination to the population being servedÂ
- Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.Â
- Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.Â
- Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.Â
- Mental concentration is required in all aspects of work.Â
- Ability to drive and sit for extended periods of time (including in rural areas)
KNOWLEDGE OF JOB:
- Ability to express ideas clearly/concisely
- Represent Vaya in a professional manner
- An ability to initiate and build relationships with people in an open, friendly, and accepting manner
- Ability to take ownership of projects from planning through execution
- Strong attention to detail and superior organizational skills
- Ability to multitask and prioritize to manage multiple projects on tight timelines
- Ability to understand the strategic direction and goals of the department and support appropriate processes to facilitate the achievement of business objectives
- Well-developed capabilities in problem-solving, negotiation, conflict resolution, and crafting efficient processes
- 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
- Proficiency in Microsoft Office and internal systems, including Excel, data analysis, and secondary research
- Demonstrated knowledge of the assessment and treatment of developmental disabilities, without co-occurring mental illness
- Have highly effective communicationÂ
- Knowledge inÂ Medicaid B and C Waivers, NC Innovations Waiver, and accreditations and apply this knowledge in problem-solving and responding to questions/inquiries
- Have a dynamic, proactive approach to assessment, screening, monitoring and coordination of care, to ensure quality supports and consistent adherence to waiver requirements
- This is a mobile position with work done in a variety of locations spending a considerable amount of time in the field
- EmployeeÂ will participateÂ inÂ andÂ maintainÂ CareÂ ManagementÂ andÂ trainingÂ andÂ proficienciesÂ asÂ 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.Â
- Problem solving, negotiation,Â arbitrationÂ andÂ conflictÂ resolutionÂ skillsÂ areÂ essentialÂ toÂ balanceÂ the needsÂ of bothÂ internalÂ andÂ externalÂ customers.Â Must be highly skilled at shifting between macro and micro level planning, maintaining both the big picture andÂ seeing thatÂ the detailsÂ areÂ covered.
- MHSU CM Managers must exhibit an extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and have considerable knowledge of the MH/SU/DD service array provided Â through the network of providers. Additional knowledge in Medicaid B and C waivers and accreditation is essential.
- TheÂ employeeÂ mustÂ beÂ detailÂ oriented,Â ableÂ to organizeÂ multipleÂ tasksÂ andÂ priorities,Â andÂ toÂ effectivelyÂ manageÂ projects from start to finish.Â Work activities quickly change according to mandated changes and changingÂ priorities within the department.Â The employee must be able to change the focus of his/her activities to meetÂ changingÂ 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. MHSU CM Manager must understand the following areas, in addition to other required trainings:
- BHÂ I/DDÂ TailoredÂ PlanÂ eligibilityÂ andÂ services
- Whole-personÂ healthÂ andÂ unmetÂ resourceÂ needsÂ (ACEs,Â Trauma,Â culturalÂ humility)
- CommunityÂ integrationÂ (IndependentÂ livingÂ skills;Â transitionÂ andÂ diversion,Â supportive housing,Â employment,Â etc)
- ComponentsÂ ofÂ HealthÂ HomeÂ CareÂ ManagementÂ (HealthÂ HomeÂ overview,Â workingÂ in aÂ multidisciplinaryÂ careÂ team,Â etc)
- HealthÂ promotionÂ (CommonÂ physicalÂ comorbidities,Â self-management,Â useÂ ofÂ IT,Â careÂ planning,Â ongoingÂ coordination)
- OtherÂ careÂ managementÂ skillsÂ (TransitionalÂ careÂ management,Â motivationalÂ interviewing,Â Person-centeredÂ needsÂ assessmentÂ and careÂ planning,Â etc)
- ServingÂ membersÂ withÂ I/DDÂ or TBIÂ (UnderstandingÂ variousÂ I/DDÂ andÂ TBIÂ diagnoses,Â HCBS,Â AccessingÂ assistiveÂ technologies,Â etc)
- ServingÂ childrenÂ (Child-Â andÂ family-centeredÂ teams,Â UnderstandingÂ ofÂ theÂ â€œSystem of Careâ€Â approach)
- ServingÂ pregnantÂ andÂ postpartumÂ womenÂ withÂ SUDÂ orÂ withÂ SUDÂ history
- ServingÂ membersÂ withÂ LTSSÂ needsÂ (CoordinatingÂ withÂ supportedÂ employmentÂ resources
- MHSUÂ CMÂ ManagersÂ shouldÂ beÂ proficientÂ inÂ theÂ aforementionedÂ essentialÂ jobÂ functions.Â JobÂ functionsÂ with higher consequences of error may be identified, and proficiency demonstrated and measured through jobÂ simulationÂ exercisesÂ administeredÂ byÂ the supervisor whereÂ aÂ minimumÂ thresholdÂ isÂ requiredÂ ofÂ theÂ position.
- In addition, MHSU CM Managers must have 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)
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).
*If RN, licensure as a North Carolina RN (see education section)
In accordance with the BH and I/DD Tailored Plan requirements mandated by the NC Department of Health and Human Services, certain Vaya Health positions are required to be filled by individuals who reside in North Carolina, meaning someone who establishes a legal domicile in North Carolina and pays income tax in North Carolina, or resides within 40 miles of the North Carolina border. New hires from outside of North Carolina will have 60 days from the date of hire to meet this requirement, if applicable to the position.
This position is required to reside in North Carolina or within 40 miles of the North Carolina Boarder.
SALARY:Â Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.