Tailored Care Management- Care Manager

Care management is a Behavioral Health care delivery model that is focused on managing all components of care for members within or across the continuum of care, with the goals of achieving quality care outcomes.  A care manager oversees the processes of care delivered to members, works collaboratively, provides leadership to the health care team, and is committed to the organization’s goals for professional care management services.

The minimum requirements for Care Manager contacts for members with behavioral health needs are as follows:

High Acuity: At least four care manager-to-member contacts per month, including at least one in-person contact with the member.

Moderate Acuity: At least three care manager-to-member contacts per month and at least one in-person contact with the member quarterly (includes care management comprehensive assessment if it was conducted in- person).

Low Acuity: At least two care manager-to-member contacts per month and at least two in-person contacts with the member per year, approximately six months apart (includes the care management comprehensive assessment if it was conducted in-person).

Essential Duties and Responsibilities include the following. Other duties may be assigned.

a). Provide professional services and treatment within the scope of NC DHHS Tailored Plan Care Management

b). Supervision will include supervisions plans. Supervision plans will be individualized and appropriate for the level of education, skill and experience of staff. DSIS will maintain documentation of the necessary individualized and appropriate clinical supervision for all staff.

c). Under the supervision of the Supervising Care Manager, the Care Manager may provide or ensure the provision of:

1) Providing education and guidance on self-advocacy to the member, family members, and support members.

2) Connecting the member and caregivers to education and training to help the member improve function, develop socialization and adaptive skills, and navigate the service system.

3) Providing information and connections to needed services and supports including but not limited to self-help services, peer support services, and respite services.

4) Providing information to the member, family members, and support members about the member’s rights, protections, and responsibilities, including the right to change providers, the grievance and complaint resolution process, and fair hearing processes.

5) Promoting wellness and prevention programs; Providing information on establishing advance directives, including psychiatric advance directives as appropriate, and guardianship options/alternatives, as appropriate.

6) Connecting members and family members to resources that support maintaining employment, community integration, and success in school, as appropriate.

7) For high-risk pregnant women, inquiring about broader family needs, offering guidance on family planning, and beginning discussions about the potential for an Infant Plan of Safe Care Promotion of family-driven, youth-guided service delivery and development of strategies built on social networks and natural or informal supports.

8) Development of, with families and youth, strategies that maximize the skills and competencies of family members to support youth and caregivers’ self-determination and enhance self-sufficiency.

9) Verifiable efforts for services and supports to be delivered in the community within which the youth and family live, using the least restrictive settings possible to preserve community and family connections and manage costs.

10) Development and implementation of proactive and reactive crisis plans in conjunction with the care plan or ISP that anticipate crises and utilize family, team and community strengths to identify and describe who does what andwhen; every member of the CFT shall be provided a copy of the plan

11) Individual and Family Supports

12) Health Promotion

d). Must provide “first responder” crisis response on a 24/7/365 basis to recipients who are receiving this service and have the capacity to respond face-to-face within 2 hours, as well as have access to the crisis plans of consumers.

e). Ensure referrals for community resources requested by beneficiary(s) are completed. Scope of Services: Care Managers will use best efforts to ensure that all the Services shall be performed promptly, timely and responsibly.

TRAINING REQUIREMENTS

Staff must maintain all trainings as required by State and Federal law and regulations.

Each staff shall be trained in the following areas:

• BH I/DD Tailored Plan eligibility and services
• Whole-person health and unmet resource needs
• Community Integration
• Components of Health Home Care Management
• Health promotion

Qualifications: Employees must possess the education, training and experience to work with the population served in the capacity and at the level of intervention for which hired.

Education and/or Experience

Care managers serving all members must have the following minimum qualifications:

(a) 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

(b) Two years of experience working directly with individuals with behavioral health conditions (if serving members with behavioral health needs) or with an I/DD or a TBI (if serving members with I/DD or TBI needs); and 

Certificates, Licenses, Registrations: Must maintain certifications in NCI, and Community First Aid/CPR and other certifications as required.