Please read this page in its entirety!

One Health Care Management

Scope of Position

The Care Manager provides care management services to members to promote whole person, integrated care. The Care Manager meets with members and guardians to assess services needed, provided and utilized. He/she will regularly communicate and collaborate with other care managers team and Care Management Supervisor to support One Health’s mission and ensure quality of service delivery.

Essential Job Functions

• Carries a caseload of members to ensure they receive and utilize all services available. Assists with acquiring other services, as appropriate.
• Ensures all timelines are established and met in the following areas:
  • Care Management Comprehensive Assessment;
  • Care Plans and Individual Support Plans (ISPs);
  • Development of the Care Team;
  • Care Coordination;
  • Twenty-four-Hour Coverage;
  • Annual Physical Exam;
  • Health Promotion;
  • Addressing unmet health-related resource needs;
  • Transitional care management;
  • Diversion; Ensuring the minimum contact requirements are met based on the members’ acuity.
• Completes daily operations of care management, including, but not limited to:
  • Completion of progress notes/encounter data and other documentation;
  • Review and analysis of data, reports and trends in the EHR and Care Management Systems.
• Develops positive working relationships with colleagues, members, guardians, and consultants.
• Assigns beneficiaries and stratifies risks.
• Assists with clinical needs within the department as it relates to member care, as needed.
• Provides clinical support to tailored care management staff and patients, as needed.
• Participates in continuous performance improvement.
• Ensures that all data requirements are met.
• Consults with behavioral health and medical providers as needed to ensure quality of care and positive patient experience within the practice.
• Works to build active, working relationships with community providers.
• Is a role model for colleagues by adhering to the stated mission, vision, and values of the organization
• Promotes collaboration for the patient’s continuum of care with all members.
• Promptly submits accurate time records as required.
• Participates in case review during huddles
• All other duties as assigned.

Qualifications

Knowledge and Competencies:

• Demonstrates passion and commitment to excellence
• Understands and can apply principals of Care Management and Person-Centered Service Planning
• Can understand and apply coverage guidelines and benefit limitations
• Familiar with clinical needs and disease processes for IDD, TBI, Innovation Waiver, and Co-Occurring IDD/Behavioral Health diagnosis in an ethnically diverse, dual-eligible population
• Understands and adapts appropriately to issues related to communication, cognitive or other barriers
• Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner
• Comfortable with conducting home visits and commuting within the service area
• Possesses basic computer skills and demonstrates a willingness to learn more advanced skills

Education/Certification/Experience

• Must meet one of the standards below:

• an individual who holds a license, provisional license, certificate, registration or permit issued by the governing board regulating a human service profession, except a registered nurse who is licensed to practice in the State of North Carolina by the North Carolina Board of Nursing who also has four years of full-time accumulated experience in mh/dd/sa with the population served;
• a graduate of a college or university with a Masters degree in a human service field and has one year of full-time, pre- or post-graduate degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has oneyear of full-time, pre- or post-graduate degree accumulated supervised experience in alcoholism and drug abuse counseling;
• a graduate of a college or university with a bachelor’s degree in a human service field and has two years of full-time, pre- or post-bachelor’s degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has two years of full-time,
• pre- or post-bachelor’s degree accumulated supervised experience in alcoholism and drug abuse counseling; or
• a graduate of a college or university with a bachelor’s degree in a field other than human services and has four years of full-time, pre- or post-bachelor’s degree accumulated mh/dd/sa experience with the population served, or a substance abuse professional who has four years of full-time,
• pre- or post-bachelor’s degree accumulated supervised experience in alcoholism and drug abuse counseling.