LOCATION: Remote - must live in or near Jackson, Swain, or Graham County, North Carolina. Incumbent in this role must live in North Carolina or within 40 miles of the NC border. This position requires travel.
GENERAL STATEMENT OF JOB
The Innovations Care Manager (Innovations CM) is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members to ensure that these individuals receive appropriate assessment and services. The Innovations CM 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 needed by the member across various health domains. Innovations CMs 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 Innovations CM also works with other Vaya staff, members, relatives, caregivers/natural supports, providers, and community stakeholders. Essential job functions of the Innovations CM include:
- Utilization of and proficiency with Vaya's Care Management software platform.
- Outreach and engagement.
- Compliance with HIPAA requirements.
- Performing Health Risk Assessments (HRA).
- Adherence to Medication List and Continuity of Care processes.
- Participation in interdisciplinary care team meetings and ongoing care management.
- Transitional Care Management.
- Diversion from institutional placement.
This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services. This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams.
ESSENTIAL JOB FUNCTIONS
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.
- Meets with members to conduct the HRA and gather information on their overall health.
- Administers screenings within their scope based on member's needs.
- Supports the care team in development of a person-centered care plan.
- Reviews clinical assessments conducted by providers and partners with the care team.
- Ensures that member/legally responsible person is informed of available services.
- Works in an integrated care team to address needs and goals.
- Supports and may facilitate Care Team meetings.
- Ensures that the assessment, care plan, and other relevant information is provided to the care team.
- Updates Care Plans and Care Management assessments.
- Participates in multidisciplinary huddles to present cases.
- Ensures individuals identified as Special Needs enrollees have a Behavioral Health Clinical Home and a Medical Home.
- Provides crisis intervention, coordination, and care management if needed.
- Supports Transitional Care Management responsibilities.
- Coordinates Diversion efforts for members at risk.
- Consults with care management licensed professionals as needed.
Support Monitoring/Coordination, Documentation, and Fiscal Accountability:
- Serves as a collaborative partner in identifying system barriers.
- Manages and facilitates Child/Adult High-Risk Team meetings.
- Participates in cross-functional clinical and non-clinical meetings.
- Ensures the health and safety of members receiving care management.
- Ensures that services are monitored for compliance with standards.
- Promotes member satisfaction through ongoing communication.
- Educates members/families on services and resources.
- Monitors services to ensure that they are delivered as outlined in the individualized service plan.
- Verifies member's continuing eligibility for Medicaid.
- Proactively monitors documentation within the AHR.
- Ensures accurate/timely submission of Service Authorization Requests.
- Participates in all required Vaya/Care Management trainings.
Other duties as assigned.
KNOWLEDGE, SKILL & ABILITIES
- Ability to express ideas clearly and communicate effectively.
- Effective interpersonal skills.
- Attention to detail and satisfactory organizational skills.
- Thorough knowledge of standard office practices and proficiency in Microsoft Office products.
- Understanding of the Diagnostic and Statistical Manual of Mental Disorders.
- Experience and knowledge of the NC Medicaid program and accreditation requirements are preferred.
- Ability to complete and maintain all trainings and proficiencies required by Vaya.
EDUCATION & EXPERIENCE REQUIREMENTS
Bachelor's degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services.
- Experience: Two (2) years of experience working directly with individuals with I/DD or TBI.
- Serving members with LTSS needs: Minimum requirements defined above.
*Must meet the criteria of being a North Carolina Qualified Professional with the population served.
Licensure/Certification Required:
- If incumbent has a Bachelor's Degree in nursing, must be licensed by the North Carolina Board of Nursing.
PHYSICAL REQUIREMENTS
- Close visual acuity to perform activities such as preparation and analysis of documents.
- Physical activity includes crouching, reaching, walking, and repetitive motion.
- Sedentary work with lifting requirements up to 10 pounds.
- Mental concentration is required in all aspects of work.
- Ability to drive and sit for extended periods of time.
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 non-exempt and is eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open Until Filled
APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.
Vaya Health is an equal opportunity employer.
