Care Manager providing integrated whole-person management to Medicaid enrolled members in North Carolina. Responsibilities include assessments, education, and collaboration with health care teams.
Responsibilities
Provide integrated whole-person Care Management under the new program Care Management model, including coordination across physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs.
Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care.
Work with members and caregivers to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care.
Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management.
Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families.
Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable.
Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness.
Utilize Hospital/Data or Electronic Medical Record system as available.
Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies.
Refer to appropriate clinical team members for interventions which are outside the Care Managers’ scope of practice and/or expertise.
Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes.
Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization.
Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication.
Respect the member’s values, experience, and help to empower members to be an advocate for their own care.
Maintain appropriate documentation in the Care Management documentation platform, in accordance with organizational policies and procedures.
Meet monthly productivity and role expectations.
Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives.
Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded.
Requirements
Requires a Bachelor's Degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area or licensure as an RN
2 years of experience working directly with individuals served by the child welfare system is preferred
Must reside in NC or within forty (40) miles of the NC Border
CCM certification preferred
Maintain a valid driver’s license with current auto liability insurance
Computer skills required including various office software and the internet; including experience with MS Office software.
Excellent communication skills – oral and written; Bilingual preferred
Knowledge of government, private sector, and community resources
Knowledge of Case Management principles
Knowledge of, and compliance with, federal and state regulations applicable to the position
Strong organizational and time management skills
Skills in establishing rapport with members and caregivers and applying techniques of assessing comprehensive health care needs.
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