Care Manager – LP
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Job Description
Care Manager coordinating licensed clinical assessments, care plans, and services for Vaya Health Medicaid members. Supporting crisis intervention, transitions, and multidisciplinary care teams.
Responsibilities:
- Provide proactive intervention and coordination of care to eligible Vaya Health members
- Assess members’ behavioral, developmental, medical, social, pharmacy, LTSS, and unmet health-related resource needs
- Identify and alleviate inappropriate levels of care and care gaps through assessment, multidisciplinary care planning, and service coordination
- Link members with appropriate formal and informal services and supports across health domains
- Conduct comprehensive Health Risk Assessments addressing social determinants of health and whole-person needs
- Administer PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other needs-based screenings
- Review and transcribe medications and maintain multisource medication lists in Vaya’s care management platform
- Support development, maintenance, and annual or life-change updates of person-centered care plans
- Ensure care plans address mental health, substance use, medical, social, and personal goals and meet NCDHHS requirements
- Review provider clinical assessments for accuracy, provide consultation and technical support, and interpret findings for care management
- Engage provider clinical staff regarding treatment options and complex member needs
- Facilitate care team meetings and collaborate with members, legally responsible persons, providers, RNs, pharmacists, physicians, families, and community stakeholders
- Develop tailored Care Management Crisis Plans and provide crisis intervention, coordination, and care management when needed
- Support Transitional Care Management and coordinate diversion efforts for members at risk of institutional placement
- Manage and facilitate Child/Adult High-Risk Team meetings with DSS, DJJ, CCNC, school systems, and community stakeholders
- Identify and address service and access-to-care gaps within Vaya’s catchment
- Monitor service provision, quality of care, compliance, critical incidents, and member health and safety
- Verify continuing Medicaid eligibility and respond to members’ movement outside Vaya’s catchment area
- Create and monitor complete, accurate, and timely documentation in the administrative health record
- Maintain compliance with HIPAA, Vaya policies, federal and state requirements, and NCDHHS contracts
- Participate in trainings, multidisciplinary huddles, committees, workgroups, meetings, and other departmental projects
- Perform other duties as assigned
Requirements:
- Master’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area
- Must meet the criteria of being a North Carolina Qualified Professional with the population served under 10A NCAC 27G .0104
- Valid licensure required: RN, LCSW, LCSWA, LCMHC, LCMHCA, LCMHCS, LPA, HSP-PA, LCAS, LCASA, LMFT, or LMFTA
- For a Master’s Degree in a Human Services Area besides Nursing: two years of experience working directly with individuals with BH conditions
- For Human Services master’s degree holders serving members with LTSS needs: two years of prior Long-Term Services and Supports and/or Home Community Based Services coordination, care delivery monitoring, and care management experience; this may be concurrent with required behavioral-health experience or experience with individuals with I/DD or TBI
- For a Master’s Degree in Nursing: four years of full-time accumulated experience in mental health with the population served; experience may be before or after RN licensure
- Ability to express ideas clearly and communicate effectively
- Ability to drive and sit for extended periods, including in rural areas
- Exceptional interpersonal skills and professional representation of Vaya
- Strong attention to detail and superior organizational skills
- Ability to make prompt independent decisions based on relevant facts
- Problem solving, negotiation, arbitration, and conflict resolution capabilities
- Intermediate to advanced proficiency in Microsoft Office products and Vaya systems
- Ability to perform clinical assessments and identify member needs
- Extensive understanding of the current Diagnostic and Statistical Manual of Mental Disorders within scope
- Considerable knowledge of the MH/SU/IDD/TBI service array provided through Vaya’s provider network
- Ability to complete and maintain all required Vaya trainings and proficiencies
- Experience working directly with individuals with I/DD or TBI preferred
- Must reside in North Carolina or within 40 miles of the North Carolina border
Benefits:
- Exempt position; not eligible for overtime compensation
- Mobile position with work done in a variety of locations, including members’ home communities
- Open until filled
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