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Job Summary: Targeted Case Manager serves individuals with mental health and substance abuse disorders who require assistance to gain access to necessary care: medical, behavioral, social, and other services appropriate to their needs. Services include case management assessment, person-centered planning, referral and linkage, monitoring, and follow-up. The Targeted Case Manager will follow specific policies and procedures for the Family Safety Program and Family Intensive Treatment.
Responsibilities Provide the following case management functions according to CIHA policy and procedure and DMA Clinical Coverage Policy 8L: case management assessment; person-centered planning; referral and linkage; and monitoring and follow-up.
Provide documentation of all treatment and clinically significant events in the Electronic Health Record as prescribed by CIHA policies and quality assurance standards.
When assigned to provide services for adults, or for children and families, fulfill duties as outlined in CIHA policy and procedure related to the specific population served.
When assigned to provide case management services for clients in the Buprenorphine Clinic, fulfill duties as outlined in CIHA policy and related procedures.
Gather and document information across medical, physical and functional, psychosocial, behavioral, financial, social, cultural, environmental, legal, and vocational or educational areas.
Develop a person-centered treatment plan geared to achieve clinical outcomes and what is important to the client.
Provide timely information to treatment team members regarding client status, progress, and safety.
Utilize judgment in carrying out CIHA policy for risk assessment and crisis intervention.
Collaborate with medical staff and other health professionals/agencies to facilitate patient care, discharge and follow-up.
Provide consultation to patient and family regarding limitations, finances, adjustment to medical condition, and ongoing treatment.
Develop and implement discharge plans, follow-up care, and transfers to other behavioral health facilities as appropriate.
Implement and follow privacy/confidentiality policies and practices for patient records and clinical information, including EBCI, CIHA, IHS, DHHS, HIPAA, JCAHO, CFR 42, or other licensing bodies.
Attend clinical staffing as part of the treatment team, facilitate discussion of client data, and formulate changes to the treatment plan.
Participate in meetings to review and identify opportunities to improve the program and treatment, and recommend corrective action; assist with changes in policy and procedure to improve service delivery.
Assist with changes in CIHA/Analenisgi policy and procedure, as needed.
Provide written, telephone, and face-to-face consultation services to schools, courts, probation officers, physicians, hospitals, medical care providers, law enforcement, social services, and community agencies.
Represent CIHA at regular team meetings for progress review and during emergency meetings dealing with high-risk situations.
Participate in community planning and implementation of programs to improve coordination of services or develop programs for the community.
Collect and report data necessary for client care according to procedure and as directed by supervisor.
Expected to obtain continuing education through in-service training and access and tuition payment for approved training seminars and workshops.
May be required to provide billable/reimbursable Targeted Case Management services to meet productivity standards for areas of responsibility, based on actual minutes billed or reimbursed hours divided by available hours.
Effectively utilize an electronic medical record and other software required for operation in the CIHA system.
May require support to CIHA primary care nurse care managers as defined by standards for specific populations.
Other duties as assigned.
Education/Experience/Minimum Qualifications “Qualified Professional” means within the mh/dd/sas system of care:
An individual who holds a license, provisional license, certificate, registration or permit issued by the governing board regulating a human service profession, except a registered nurse licensed in North Carolina with four years of mh/dd/sa experience with the served population; or
Graduate with a Master’s degree in a human service field and one year of mh/dd/sa experience with the served population, or a substance abuse professional with one year of supervised experience in alcoholism and drug abuse counseling; or
Graduate with a bachelor’s degree in a human service field and two years of mh/dd/sa experience with the served population, or a substance abuse professional with two years of supervised experience in alcoholism and drug abuse counseling; or
Graduate with a bachelor’s degree in a field other than human services and four years of mh/dd/sa experience with the served population, or a substance abuse professional with four years of supervised experience in alcoholism and drug abuse counseling.
This category includes Substance Abuse Professional, Certified Alcohol and Drug Counselors (CDAC), Certified Clinical Supervisor (CCS), Licensed Clinical Addiction Specialist (LCAS).
Job Knowledge Knowledge of the population served.
Knowledge of Cherokee culture preferred.
Skill in establishing rapport and assessing psychological, behavioral, and psychosocial aspects of patients’ problems.
Ability to establish and maintain effective working relationships with caseload members, families, other professionals, and community resources.
Ability to express ideas clearly and plan and execute work effectively.
Knowledge of crisis intervention with individuals and families in distress.
Initiative in daily tasks and problem solving.
Knowledge of principles and practices in complex casework, group work, and community problems.
Knowledge of medical, behavioral, and psychosocial problems and linkage to treatment.
Knowledge of governmental and private resources in the community.
Knowledge of laws, regulations, and policies governing the program.
Understanding the impact of mental illness on treatment decisions and available programs.
Willingness to learn more about Cherokee culture and population considerations.
Complexity of Duties This position requires maximizing available resources to develop and maintain behavioral health services for EBCI children and families. Requires interpretation of policy, laws, and regulations to make decisions when no precedent exists. Duties require judgment and problem solving; decisions may involve serious risk and safety considerations. May involve working with highly agitated or distressed individuals.
Supervision Received Works under the direct guidance of the Adult TCM supervisor, Medication Assisted Treatment Manager, and/or Behavioral Health Clinical Director. Works independently within licensing regulations with latitude for initiative to achieve department goals.
Responsibility for Accuracy Accurate documentation and clear communication are essential for client care and program operation. Adherence to policy and procedure is required; errors can have significant health and liability consequences for CIHA.
Contact With Others Interacts with coworkers, hospital staff, patients, and other health professionals. May serve on committees or advisory councils. Maintains confidentiality and professional conduct.
Confidential Data Maintaining confidentiality of patient information is mandatory. Comply with EBCI confidentiality policy, CIHA policies, HIPAA, and related laws. Violations may result in disciplinary action.
Emergency Privileges In emergencies, qualified medical staff may perform necessary actions to save a life or prevent serious harm, as permitted by license and available qualified personnel.
Mental/Visual/Physical Environment Job duties can be mentally and emotionally demanding. Requires concentration, mobility, and the ability to present training. May involve travel and lifting up to 30 lbs.
Position requires: stand (under 1/3 time); walk (under 1/3 time); sit (to 2/3 time); talk or hear (over 2/3 time).
Work Environment Location is primarily at the PHHS building with potential community, hospital, or clinic settings. May involve travel and exposure to health hazards. Adherence to OSHA guidelines is required.
Customer Service Demonstrates strong customer service aligned with CIHA values and ensures service is provided to all patients/customers.
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