Innovations Care Manager (QP)-Mobile/Remote (NC)

**This is a mobile position which will work primarily out in the assigned communities.** Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus planMedical, dental, and vision insurance with low deductible/low cost health planGenerous vacation and sick time accrual12 paid holidaysState Retirement (pension plan)401(k) Plan with employer matchCompany paid life and disability insuranceWellness ProgramsPublic Service Loan Forgiveness Qualifying EmployerSee attachment for additional details. Office Location: Mobile/Remote position; Available for Davie/Davidson/Forsyth counties, NC.Projected Hiring Range: Depending on ExperienceClosing Date: Open Until Filled Primary Purpose of Position: The Innovations Care Manager is responsible for providing Tailored Care Management for members with intellectual/developmental disabilities enrolled in the NC Innovations waiver. The Innovations Care Manager is responsible for addressing members’ whole-person needs alongside coordinating and monitoring their waiver services. The Innovations Care Manager actively engages with members through comprehensive assessment, care planning, health promotion, and comprehensive transitional care. If members enrolled in the waiver opt out of Tailored Care Management, the member will remain enrolled in the waiver and the Care Manager will provide Care Coordination to monitor and coordinate waiver services. Travel is an essential function of this position. Role and Responsibilities:Duties of the Innovations Care Manager include, but are not limited to, the following: Comprehensive Care Management Provide assessment and care management services aimed at the integration of primary, behavioral and specialty health care, and community support services, using a comprehensive person-centered care plan which addresses all clinical and non-clinical needs and promotes wellness and management of chronic conditions in pursuit of optimal health outcomesComplete a care management comprehensive assessment within required timelines and update as neededDevelop a comprehensive Individual Support Plan and update as neededEnsure that the member/legally responsible person (LRP) and all others responsible for plan implementation sign the plan and updatesEducate members/LRP on methodology for budget development, total dollar value of the budget and mechanisms available to modify the member budget. Educate the member/LRP on waiver requirements/limits, however, ensures services, as requested are outlined in the budget.Secure service authorizations for all Innovations waiver servicesEnsures that service orders/doctor’s orders are obtained, as applicableProvide diversion activities to support community tenure Monitor services based on Innovations Waiver, Home and Community Based Standards and Tailored Plan requirements Care CoordinationFacilitate access to and the monitoring of services identified in the Individual Support Plan to manage chronic conditions for optimal health outcomes and to promote wellness. Facilitate communication and regularly scheduled interdisciplinary team meetings to review care plans and assess progress.Make announced/unannounced monitoring visits, including nights/weekends as applicableMonitor services for compliance with state standards, waiver requirements, and Medicaid regulations, as applicableMonitor to ensure that any restrictive interventions (including protective devices used for behavioral support) are written into the ISP and the Positive Behavior Support PlanVerify that services are delivered as outlined in person centered plan and addresses any deviations in servicesNotify Utilization Management of any suspected or actual changes in level of careMonitor compliance with home and community-based standards Individual and Family SupportsProvide education and guidance on self-management and self-advocacy Provide information to the member about the member’s rights, protections, and responsibilities, including the right to change providers, the grievance and complaint resolution process, and fair hearing processesHelp members make informed choices of care team participants, provide information about providers, and arrange provider interviews as needed Health Promotion Educate and engage the member and member’s caregivers in making decisions that promote his/her maximum independent living skills, good health, pro-active management of chronic conditions, early identification of risk factors, and appropriate screening for emerging health problems Transitional Care Management Facilitation of services for the member and family/caregiver when the member is experiencing care transitions (including, but not limited to transitions related to hospitalization, nursing facility, rehabilitation facility, community-based group home, etc.), significant life changes including, but not limited to loss of primary caregiver, transition from school services, etc.) or when a member is transitioning between health plans. Create and implement a 90-day transition plan as an amendment to the member’s ISP that outlines how the member will maintain or access needed services and supports, transition to the new care setting, and integrate into his or her community. Proactively responds to a member’s planned movement outside the LME/MCO geographic area to ensure changes in their Medicaid County of eligibility are addressed prior to any loss of service Referral to Community/Social Supports Provide information and assistance in referring members to community-based resources and social support services, regardless of funding source, which can meet identified needsProvide comprehensive assistance securing health-related services, including assistance with initial application and renewal with filling out and submitting applications and gathering and submitting required documentation, including in-person assistance when it is the most efficient and effective approach Other:Verify member’s continuing eligibility for Medicaid with Indicators and promptly follows-up on identified issues, as indicatedCoordinate Medicaid deductibles, as applicable, with the member/legally responsible person and provider(s)Proactively monitor own documentation/billing to ensure that issues/errors are resolved as quickly as possibleEnsure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirementsMaintain medical record compliance/quality, as demonstrated by ≥90% compliance on Qualitative Record Reviews Document within the grievance system any expression of dissatisfaction/concern expressed by members supported or others on behalf of the member supportedEnsure strong leadership to care team, including effectively communicating with and providing direction to Care Management extenders Knowledge, Skills and Abilities:Demonstrated knowledge of the assessment and treatment of I/DD needs, with or without co-occurring physical health, mental health or substance use disorder needsAbility to develop strong, person-centered plans Exceptional interpersonal skills, highly effective written and oral communication skills, and the propensity to make prompt independent decisions based upon relevant facts and established processesDemonstrated ability to collaborate and communicate effectively in team environmentAbility to maintain effective and professional relationships with members, family members and other members of the care teamProblem solving, negotiation and conflict resolution skillsExcellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)Detail orientedAbility to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiriesAbility to independently organize multiple tasks and priorities and to effectively complete duties within assigned timeframesAbility to manage and uphold integrity and confidentiality of sensitive dataSensitivity and knowledge of different cultures, ethnicities, spiritual beliefs and sexual orientation. Education and Experience Required: Bachelor’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area and two (2) years of full-time experience with I/DD population OR Bachelor’s degree in a field other than human services and four (4) years of full-time experience with I/DD population ORMaster’s degree in human services and one (1) year of full-time experience with I/DD population ORLicensure as a registered nurse (RN) and four (4) years of full-time accumulated experience with I/DD ANDTwo (2) years of prior Long-Term Services and Supports (LTSS) and/or Home and Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working with I/DD population described aboveANDMust reside in North Carolina or within 40 miles of the NC borderMust have ability to travel regularly as needed to perform job duties Education/Experience Preferred: Experience working with members with co-occurring physical health and/or behavioral health needs preferred. Licensure/Certification Requirements: If a Registered Nurse (RN), must be licensed in North Carolina.

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