Care ManagerService Definition and Required Components Through Tailored Care Management, Behavioral Health I/DD Tailored Plan beneficiaries will have a designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all their needs, spanning physical health, behavioral health, I/DD, traumatic brain injury (TBI), pharmacy, long-term services and supports (LTSS) and unmet health related resource needs. Responsibilities include but not limited to the following:Complete comprehensive assessments at enrollment, yearly or at changes in condition.Develop Plans of Care derived from the completed assessmentsAssign interventions/plans of care to the Care Worker for monitoring and service engagement activities. Address, in the Plan of Care, if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues.Assist individuals/legally responsible persons (LRP in choosing service providers, ensuring objectivity in the process.Utilize ADT information to respond within hours/minutes as appropriate to support members who are admitted, transferred, or discharged from a facility in a timely mannerConsistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification. Utilize person centered planning, motivational interviewing, and historical review of assessments to gather information and to identify supports needed for the individual.Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goalsSubmit required documentation to the payor to ensure timely delivery of services - and trouble shoots until authorization is obtained. Notifies care team as appropriate of successful authorization.Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information.Completes activities related to Plans of Care For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled. Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan.Schedule and facilitate the Care Plan meeting.Develop and update Care PlanSubmit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver.Coordinate with other team members to ensure smooth transition to appropriate level of care. Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email. Update other Care Team members of urgent or pertinent treatment updates Recognize and report critical incidents to supervisors. Schedule face to face meeting with member/LRP to provide education about care teams, services, needed supports, etc. Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance.Escalate complex cases and cases of concern to Supervisor.Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.Verify ongoing service adherence with member and/or guardianDocument all applicable member updates and activities per organizational procedure.Ensure that service orders/doctor’s orders are obtained, as applicable.Obtain releases/documentation and provide to all stakeholders involved. Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release informationEnsure clinical documentation (e.g., goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements.Participate and complete all required agency trainings and meetings, as well as all required care management-based trainings from the State, Technical Assistance entity or payor and within required timeframes as assigned.Travel to various community locations, other agencies, and other outreach destinations as necessary to meet the members’ needs.Maintain all certification(s) or licensure required for the position.Demonstrate awareness and knowledge of and comply with all agency policies and procedures, as well as state and federal statutes and regulations related to care management.Meet at least minimum standards of monthly contacts and demonstrate ability to effectively engage with members.Care manager will coordinate the member’s health care and social services including behavioral health, LTSS and pharmacy services as well as other SDOH needs.Participate in agency’s twenty-four (24) hour coverage around care management providing for coverage for services, consultation or referral as needed and arrange treatment for emergency medical conditions including behavioral health crises. Specifically, coverage will include the ability to share information such as care plans and psychiatric advance directives and coordinate care to place the member in appropriate setting during urgent and emergent events.Complete all other relevant responsibilities as assigned by supervisor.Complete all required trainings per service definition, rule CARF, agency, etc. Service Type and Program Requirements· Person Centered Thinking/planning· Knowledge of using assessments to develop plans of care· Knowledge of LOC processes· Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans· Knowledge of and skilled in the use of Motivational Interviewing· Knowledge of and skilled in the use of Motivational Interviewing techniques· Strong interpersonal and written/verbal communication skills· Conflict management and resolution skills· Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)· High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.· Ability to make prompt, independent decisions based upon relevant facts· Good organizational skills to prioritize duties and work with minimal levels of onsite supervision to consistently meet deadlines Staff Qualifications and Role· 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) and· Two years of experience working directly with individuals with behavioral health conditions (if serving members with behavioral health needs) or with I/DD or a TBI condition(s) and· For Care managers serving members with LTSS needs: two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience, in addition to the requirements cited above. #NCC