MHSU Care Manager
Company: Vaya Health
Location: Lenoir
Posted on: January 24, 2023
Job Description:
LOCATION: Remote - Caldwell County, NC
GENERAL STATEMENT OF JOB:The Mental Health/Substance Use (MHSU)
Care Manager, hereafter referred to as care manager, is responsible
for providing proactive intervention and coordination of care to
eligible members and recipients of Vaya's Health plan to ensure
that these individuals receive appropriate assessment and services.
This Care Manager does not provide Home and Community Based
Services (HCBS) Waiver care coordination. The Care Manager works
with the member and care team to alleviate inappropriate levels of
care or care gaps through assessment, 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. Care Managers support and may provide clinical
transition planning assistance to local hospitals and tracks
individuals discharged from state and community hospitals 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. The Care Manager
may work with members in their home communities. The Care Managers
also works with other Vaya staff, members and family members,
providers as well as community stakeholders. Essential job
functions of the Care Managers 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
- Transitoinal Care Management
- Diversion *Must reside in North CarolinaNote: 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 Vaya Health. The
individual filling this position shall also sign a confidentiality
statement as an employee of Vaya Health.
ESSENTIAL JOB FUNCTIONS:Assessment, Care Planning and
Interdisciplinary Care Team:
- Ensure 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 Care Management populations and link
appropriate formal/ informal services and supports (i.e. medical
and behavioral health home)
- 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
- Health Risk Assessment (HRA) is a comprehensive 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 care
- May administer the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and
other screenings within their scope based on member's needs
- Scores are calculated and reviewed allowing MH/SU Care Manager
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 to trigger the continuity of care process which results in
the creation of a multisource medication list that is shared back
with prescribers to promote integrated care.
- Use assessment to learn about member's needs to aide in care
planning,
- Create a person-centered care plan for members 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 and ensure Care Plan includes specific services to address
mental health, substance use, medical and social needs as well as
personal goals
- Care Plans are created based on information collected in the
assessment process
- Ensure members of the care team are involved as indicated by
the member/guardian(s) and that other available clinical
information is reviewed and incorporated into the assessment as
necessary
- Work with members to mediate dissatisfaction within the
community
- Assist members in refining and formulating treatment goals,
identifying interventions, measurements and barriers to the
goals
- Ensures that member/guardian(s) is/are informed of available
services, referral processes (e.g., requirements for specific
service), etc.
- Provide information to member/guardian(s) regarding their
choice in choosing service providers, ensuring objectivity in the
process
- Work 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/guardian(s)
have the opportunity to decide who they want involved
- Coordinates and may facilitate Care Team meetings where member
Care Plan is discussed and reviewed
- Solicit input from the care team and monitor progress
- Ensures that the assessment, care plan and other relevant
information is provided to the care team as indicated in Vaya
policy and necessary Care Plan elements are included
- Review assessments conducted by providers and consult with
clinical staff as needed to ensure all areas of the member's needs
are addressed
- Update Care Plans and Care Management assessment at a minimum
of annually or when there is a significant life change for the
member
- Conducts education and referral to prevention and population
health management programs.
- Create a Care Management Crisis Plan which is separate and
complimentary to the behavioral health provider's crisis plan
- Collaborate with members to develop a Crisis Plan that is
tailored to their needs and desires
- Conducts Transitional Care Management responsibilities
- Coordinates Diversion efforts for members at risk of requiring
care in an institutional setting
- Link members to necessary services and supports across all
health domains.
Collaboration, Coordination, Documentation:
- 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 address
identified needs within the catchment.
- CM 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 CM's and receiving support and
feedback regarding CM interventions for clients' medical,
behavioral health, intellectual /developmental disability,
medication, and other needs.
- CM participates in other high risk multidisciplinary complex
case staffing's as needed to include Vaya 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.
- Ensure quality care, health/safety of the individual, as well
as the continued appropriateness of services
- Monitor services for compliance with standards
- Promote problem-solving and goal-oriented partnership with
member/guardian(s), providers, etc. and recognize and report
critical incidents
- Promote satisfaction through ongoing communication and timely
follow-up on any concerns/issues
- Educate members/families on services and resources.
- Verify member continuing eligibility for Medicaid
- Promptly follow-up on issues
- Proactively responds to an member's planned movement outside
the Vaya's geographic area to ensure changes in their Medicaid
County of eligibility are addressed prior to any loss of
service
- 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 all clinical and non-clinical documentation (e.g. goals,
plans, progress notes, etc.) meet state, agency and Medicaid
requirements
- Participate in and maintain Care Management and Vaya trainings
and proficiencies
Other duties as assigned.
QUALIFICATIONS & CREDENTIALING REQUIREMENTS: Bachelor's Degree in a
field related to health, psychology, sociology, social work,
nursing or another relevant human services area or licensure as an
RN* (see licensure section) and the following experience:
- Serving members with BH conditions:
- Two (2) years of experience working directly with individuals
with BH conditions
- Serving members or recipients with an I/DD or Traumatic Brain
Injury (TBI)
- Two (2) years of experience working directly with individuals
with I/DD or TBI
- Serving members with LTSS needs
- Minimum requirements defined above
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)
KNOWLEDGE OF JOB:
- Ability to express ideas clearly/concisely
- Ability to drive and sit for extended periods of time
(including in rural areas)
- 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
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 Vaya systems, to include
Excel, data analysis, and secondary research
- Demonstrated knowledge of the assessment and treatment of
developmental disabilities, without co-occurring mental
illness
- Have highly effective communication
- Employee will participate in and maintain Care Management and
Vaya 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
internal and external customers.
- Must be highly skilled at shifting between macro and micro
level planning, maintaining both the big picture, and seeing that
the details are covered.
- Care 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 through the network of Vaya providers.
- Additional knowledge in Vaya Medicaid B and C waivers and
accreditation is essential.
- The employee must be detail oriented, able to organize multiple
tasks and priorities, and to 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.
- Care Managers 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
- Care Managers 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, MHSU CM 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.)
LICENSURE:*If RN, licensure as an North Carolina RN (see education
section)
LOCATION REQUIREMENT: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: 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 http://www.vayahealth.com/careers-overview/
Ind.001
Vaya Health is an equal opportunity employer.
Keywords: Vaya Health, Gastonia , MHSU Care Manager, Executive , Lenoir, North Carolina
Didn't find what you're looking for? Search again!
Loading more jobs...