The Care Manager II-Facility Based provides Transitional Care Management and
Physical Health Consultation for members with physical and/or behavioral health
needs in Acute Care facilities, State Operated Developmental Centers, and
Justice System settings. For Care Manager II-Facility Based assigned to a
facility, there will be active and onsite participation in discharge planning
beginning with admission.
Responsibilities & Duties-
Provide Care Team Support
Support members transitioning from inpatient settings to the appropriate and
least restrictive lower or lateral level of care
Provide subject matter expertise, within scope, regarding member’s physical
and/or behavioral health to support the development and delivery of a whole
person approach to Care Management
Work collaboratively with other Alliance staff, behavioral health providers,
primary care physicians, specialty care providers and other community
partners and stakeholders to support members in their home communities and
address barriers
Core Transitional Care Management Functions
Conducts on site visit the member during their stay in an institution (e.g.,
acute, subacute and long–term stay facilities)
Conduct outreach to the member’s providers
Obtain a copy of the discharge plan ensure discharge plan is made available
to authorized community providers who will be serving the member post
discharge
Facilitate clinical handoffs to other Health Plans and Providers as
applicable
Refer and assist members in accessing needed social services and supports
identified as part of the transitional care management process, including
access to housing, behavioral health services, residential services and
supports, medical and wellness services
Assist the member in obtaining needed medications prior to discharge, ensure
an appropriate care team member conducts medication reconciliation/management
and support medication adherence
Develop a ninety (90) day post-discharge transition plan prior to discharge
from residential or inpatient settings, in consultation with the member,
facility staff and the member’s care team, that outlines how the member will
maintain or access needed services and supports, transition to the new care
setting, and integrate into their community
Communicate and provide education to the member and the member’s caregivers
and providers to promote understanding of the ninety (90) day post-discharge
transition plan
Assist with scheduling of transportation, in-home services, and follow-up
outpatient visits with appropriate providers within a maximum of seven (7)
Calendar Days post-discharge, unless required within a shorter timeframe
Conduct In reach and transitions for Special Populations receiving care in
Inpatient settings (PRTF, SNF’s)
Monitoring/Coordination
Appropriately escalate high risk/high visibility and/or complex
barriers/needs members who may have difficulty transitioning out of the
facility in a timely manner to supervisors. High risk can involve Health and
Safety of a member, staff, or organizational risk
Review cases with clinical complexity with direct supervisor and follow
escalation protocols to ensure timely engagement from members or our Medical
Team and Provider Networks
Obtain information releases that will improve care management activities on
behalf of the member
Reports care quality concerns to Quality Management as needed
Documentation
Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.)
meet state, agency, and Medicaid requirements
Follow administrative procedures and effectively manages caseload
Data
Review, validate and interpret risk stratification data and population health
groups and recommend changes or adjustments to care management approach as
needed
Utilize data to analyze needs of the members we serve, guide staff training
development, identify resource needs and consistency of workflow
implementation across disciplines
Travel
Travel between Alliance offices, attending meetings on behalf of Alliance,
participating in Alliance sponsored events, etc. may be required
Travel to meet with members, providers, stakeholders, attend court hearings
etc. is required
Minimum Requirements-
Education & Experience
Required:
Graduation from an accredited school of Nursing and three (3) years of
full-time, post degree experience providing care management, case management,
care coordination, discharge planning, or utilization management to members with
Behavioral Health and Physical Health conditions in a behavioral health,
medical, or managed care setting. Must have a valid, active RN license in North
Carolina.
Or
Master’s degree from an accredited college or university in Human Services or
related field and at least two (2) years of full-time, post graduate degree
experience providing care management, case management, care coordination,
discharge planning, or utilization management to members with Behavioral Health
and Physical Health conditions in a behavioral health, medical, or managed care
setting. Must have a valid, active clinical license (LCSW, LMFT, LCAS, LCMHC,
LPA) in North Carolina.
Knowledge, Skills, & Abilities-
A demonstrated Knowledge of the assessment and treatment of mental health,
substance abuse, intellectual and developmental disabilities,
Knowledge of legal, waiver, accreditation standards and program
practices/requirements.
Knowledge of the Alliance Health service benefit plans and network
providers.
Person Centered Thinking/planning
The employee must be detail oriented,
Ability to independently organize multiple tasks, priorities, and to
effectively manage an assigned caseload under pressure of deadlines.
Exceptional interpersonal skills, highly effective communication ability,
Ability to make prompt independent decisions based upon relevant facts and
established processes.
Problem solving, negotiation and conflict resolution skills
Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
is required.
Salary Range
$69,592-$88,729/Annually
Exact compensation will be determined based on the candidate's education,
experience, external market data and consideration of internal equity.