Care Manager - LP; Caldwell County, NC

Overview

Location:

Remote - must live in or near Caldwell County, North Carolina. The person in this position is required to maintain residency in North Carolina or within 40 miles of the North Carolina border. This position requires travel.

The Care Manager Licensed Professional ("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 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, I/DD, TBI, physical health, pharmacy, LTSS, and unmet health-related resource needs networks.

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 performed in a variety of locations, including members  home communities.

The Care Manager - LP also works with other Vaya staff, members, relatives, caregivers/natural supports, providers, and community stakeholders. The 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 described below, essential job functions of the Care Manager - LP include, but are not limited to:

• Utilization of and proficiency with Vaya s Care Management software platform/administrative health record ("AHR").
• Outreach and engagement.
• Compliance with HIPAA (Health Insurance Portability and Accountability) requirements, including Authorization for Release of Information ("ROI") practices.
• Performing 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 care.
• Adherence to Medication List and Continuity of Care processes.
• Participation in interdisciplinary care team meetings, comprehensive care planning, 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 ("NCDHHS" or "Department"). The position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams.

• Utilizes advanced knowledge in their work which requires use of their advanced degree and licensure to participate in 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 presentations and needs, providing support to other CMs and receiving support and feedback regarding CM interventions for clients  medical, behavioral health, I/DD, TBI, 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 and 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, recognizes and reports critical incidents, and escalates concerns about health and safety to care management leadership as needed.
• Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other…