Overview
I/DD Care Manager, QP (Gaston/Cleveland/Rutherford NC) - Mobile
Location: Available for Gaston, Cleveland, Rutherford, NC locations; Mobile/Remote position. Travel is an essential function of this position.
Primary Purpose of Position
The Intellectual and Developmental Disabilities (I/DD) Care Manager is responsible for providing Tailored Care Management and/or care coordination to members/recipients with I/DD to help secure and coordinate a variety of physical health, developmental disability, behavioral health and long-term services and support (LTSS) services. The I/DD Care Manager actively engages with members/recipients through comprehensive assessment, care planning, health promotion, and comprehensive transitional care. Tailored Care Management is comprehensive and longitudinal for members with Medicaid coverage. Recipients with no Medicaid receive Tailored Care Management based on specified triggers and for a duration not to exceed ninety (90) days.
Responsibilities
Comprehensive Care Management: Provide assessment and care management services aimed at integrating primary, behavioral and specialty health care and community support services using a comprehensive person-centered care plan addressing all clinical and non-clinical needs and promoting wellness and management of chronic conditions.
Complete a care management comprehensive assessment within required timelines and update as needed.
Develop a comprehensive Individual Support Plan and update as needed.
Provide diversion activities to support community tenure.
Care Coordination: Facilitate access to and monitoring of services identified in the ISP to manage chronic conditions and promote wellness.
Facilitate communication and regularly scheduled interdisciplinary team meetings to review care plans and assess progress.
Monitor services for compliance with state standards and Medicaid regulations, including HBBS standards for 1915i services.
Verify services are delivered as outlined in ISP and address deviations in services to the extent applicable.
Provide education and guidance on self-management and self-advocacy.
Provide information about rights, protections and responsibilities, including changing providers, grievance/complaint resolution, and fair hearing processes.
Educate members about the Registry of Unmet Needs with referral as indicated.
Use person-centered planning methods to gather information and understand the member.
Ensure members/representatives are informed of services and options available, and processes required for specific services.
Promote prevention and health through education on chronic conditions and disabilities for members, families, and caregivers/support members.
Promote culturally competent services and supports.
Health Promotion
Educate and engage the member/recipient and caregivers in decisions that promote independent living, good health, proactive management of conditions, early risk identification, and appropriate screening.
Coordinate care with I/DD, behavioral health, and physical health providers, including in-person visits to EDs and SNFs when needed.
Support medication management as prescribed, focusing on adherence, side effects, and effectiveness.
Transitional Care Management
Proactive care management during transitions (e.g., hospitalization, facility moves, school service transitions, changes in health plans) and during significant life changes.
Create and implement a 90-day transition plan as an amendment to the ISP detailing service maintenance and transition to the new setting.
Referral to Community/Social Supports
Provide information and assistance referring to community-based resources and social support services.
Assist with securing health-related services, including initial applications and renewals, documentation gathering, and in-person assistance when efficient.
Other
Assist state-funded recipients apply for Medicaid and coordinate Medicaid deductibles with the member/representative and providers.
Monitor documentation and billing to resolve issues quickly; ensure clinical documentation meets state, agency and Medicaid requirements.
Maintain medical record compliance with ≥90% on Qualitative Record Reviews.
Recognize and report critical incidents; promote member satisfaction through ongoing communication and timely follow-up.
Collaborate with providers to ensure accurate and timely submission of authorization requests for Tailor Plan-funded services/supports.
Document concerns in the grievance system and provide leadership to the care team for each member/recipient.
Knowledge, Skills, And Abilities
Knowledge of assessment and treatment of I/DD needs, with or without co-occurring conditions.
Ability to develop strong, person-centered plans.
Excellent interpersonal and communication skills; ability to make prompt independent decisions.
Ability to collaborate effectively in a team environment and maintain professional relationships with members, families, and care team.
Problem solving, negotiation and conflict resolution skills.
Strong computer skills (Microsoft Word, Excel, Outlook, etc.).
Detail oriented; ability to learn and apply legal, waiver and program requirements.
Ability to manage multiple tasks and priorities within timeframes; maintain data integrity and confidentiality.
Sensitivity to and knowledge of diverse cultures, ethnicities, beliefs and sexual orientation.
Education/Experience Required
Bachelor’s degree in health, psychology, sociology, social work, nursing or related field and two (2) years of full-time experience with I/DD population OR
Bachelor’s degree in a non-human-services field with four (4) years of full-time experience with I/DD population OR
Master’s degree in human services with one (1) year of full-time experience with I/DD population OR
Licensure as a registered nurse (RN) with four (4) years of related experience
Two (2) years of LTSS and/or HCBS coordination, care delivery monitoring and care management experience (may be concurrent with the above).
Must reside in North Carolina and have ability to travel regularly as needed.
Education/Experience Preferred
Experience working with members/recipients with co-occurring physical health and/or behavioral health needs is preferred.
Licensure/Certification Requirements
If a Registered Nurse (RN), must be licensed in North Carolina.