TCM Care Manager - Partners Catchement Area

Job Description

Job Description

Description:

Position: Care Manager

Department: Tailored Care Management

Remote Work Position: Hybrid/Remote

Location: Partners Catchment Area (We are filling multiple slots for this position)

Reports To: Tailored Care Management Supervisor

Scope of Work Summary: The Care Manager is part of a multidisciplinary care team providing whole-person care management for Behavioral Health I/DD Tailored Plan beneficiaries. The role spans multiple domains, including physical health, behavioral health, I/DD, traumatic brain injury (TBI), pharmacy, long-term services and supports (LTSS), and unmet health-related resource needs.

Expectations :

Assessment and Care Planning:

· Conduct comprehensive assessments at enrollment, yearly, or during changes in condition.

· Develop, update, and facilitate Care Plans derived from these assessments.

· Utilize person-centered planning, motivational interviewing, and historical review of assessments to identify required supports.

· Address Social Determinants of Health (SDOH), disparities, and complex payer issues in the Plan of Care.

Coordination and Support:

· Assign interventions/plans of care to Extenders [KO1] [JC2] for monitoring and service engagement.

· Coordinate with team members for smooth transitions to appropriate levels of care.

· Participate in the agency’s twenty-four (24) hour coverage for care management.

Education and Customer Service:

· Educate members/Legally Responsible Persons (LRP) about care teams, services, rights, the grievance and appeals process, available service options, and payer requirements.

· Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.

Compliance and Documentation:

· Ensure adherence to service orders/doctor’s orders and obtain necessary releases/documentation.

· Submit necessary documentation to the payer for timely service delivery.

· Maintain all certifications or licensure required for the position and comply with all agency policies and procedures.

Risk Management:

· Evaluate the appropriateness of services and ensure the implementation of the plan of care through regular assessments.

· Escalate complex cases to the Supervisor and report critical incidents.

· Attend Behavior Support Plan (BSP) meetings.

Additional Duties:

· Assist individuals/LRP in choosing service providers, ensuring objectivity.

· Utilize Admission, Discharge, and Transfer (ADT) information to support members admitted, transferred, or discharged from a facility promptly.

· Collaborate with the care team and service providers to develop plans reflecting the individual’s needs and desired life goals.

· Complete all other responsibilities as assigned by the supervisor.

· Visiting members at their living arrangements, such as their own home, a relative's home, a care facility, or any other location, is essential and required to ensure the delivery of high-quality care.

HealthKeeperz Employee Expectations :

As a valued member of the HealthKeeperz team, the Care Manager is expected to embody the principles of the HealthKeeperz Barnabas Culture of Encouragement. This involves fostering a supportive and inclusive work environment, promoting teamwork, and upholding the core values of the organization, which include compassion, excellence, ownership, and putting family first.

In your role as Care Manager, you are encouraged to exemplify these values, demonstrating a commitment to the mission of HealthKeeperz: caring for all people for the glory of God. By aligning your work ethic and professional conduct with HealthKeeperz's mission, vision, values, and culture, you will contribute significantly to the organization's ongoing success.

Your efforts will play a crucial role in providing high-quality care to the individuals we serve and maintaining productive relationships with our colleagues and stakeholders. Your contribution will help ensure that HealthKeeperz continues to thrive as an environment of care, collaboration, and excellence.

Results

The Tailored Care Management Care Manager is expected to produce the following results in the four key pillars of the HealthKeeperz vision statement.

· Culture

o Every individual interacting with HealthKeeperz should be provided with opportunities to flourish.

o You, as a Care Manager, should flourish and feel valued and cared for as an individual and a contributor to the team.

o When you bring your whole self to your work, ready to fully engage, you play a part in building a fantastic team where life-giving work, outstanding talent, uplifting growth, rewarding compensation, inspirational leadership, sustainable strategies, and healthy communication are the norms.

o As you flourish, your team can flourish, TCM beneficiaries can flourish, and our communities can flourish.

· Innovation

o Employees are encouraged to think creatively, take calculated risks, and generate new ideas.

o Internal and external collaboration will be encouraged.

o You play a vital role in driving innovation within our organization, ensuring that HealthKeeperz delivers the highest level of care to our beneficiaries and achieves improved outcomes.

· Excellence

o Fostering a culture of compliance and excellence that sets clear expectations.

o Achieving compliance and excellence in regulatory compliance, quality metrics, and safety outcomes.

o Enhancing patient outcomes through continuous improvement and innovative approaches.

· Financial Health

o Your role contributes to meeting revenue, margin, and collection goals. o Your efforts help create opportunities for HealthKeeperz to engage in the ministry of financial stewardship.

Service Type and Program Requirements:

· Proficiency in Person-Centered Thinking/planning

· Experience using assessments to develop plans of care

· Knowledge of LOC processes

· Familiarity with Medicaid basic, enhanced MHSUD, and waiver benefits plans

· Proficiency in using Motivational Interviewing techniques

· Strong interpersonal and written/verbal communication skills

· Conflict management and resolution skills

· Proficiency in Microsoft Office products

· Ability to make prompt, independent decisions

· Good organizational skills to prioritize duties and meet deadlines

Education/Certifications

· A Bachelor’s degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area, or licensure as a registered nurse (RN)

· Two years of experience working directly with individuals with behavioral health conditions, I/DD or TBI condition(s)

· For Care managers serving members with LTSS needs: two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.

Physical Demands:

The above statements describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required for the position. This position also requires standing, sitting, walking, lifting, and other physical activities for extended periods, including driving. All employees may have other duties assigned at any time.