Rn Care Manager

LOCATION: Remote - must live in or near McDowell County, North Carolina. This person must reside in North Carolina or within 40 miles of the NC border. This position requires travel.

GENERAL STATEMENT OF JOB

Performs RN functions for Care Management members that are medically fragile or have significant chronic health conditions, have a mental health, substance use, intellectual/developmental disability and/or co-occurring disorders who are identified as meeting the risk stratification levels of the complex care platform and stratification system within Medicaid or High Risk/High Cost definitions. This position will work collaboratively with Vaya staff, behavioral health providers, Primary Care Physicians, specialty care providers and other community partners and stakeholders to support members in their home communities. Work is performed under the supervision of the Sr. Director of Care Management Strategy or Medical Director of Integrated Care with Clinical Oversight provided by the RN Care Management Manager. Essential job functions include, but may not be limited to:

• CM Platform basics
• Outreach & Engagement
• Release of Information practices
• Health Risk Assessment
• Medication List and Continuity of Care process
• Care Planning
• Interdisciplinary Care Team and Ongoing Care Management

ESSENTIAL JOB FUNCTIONS

Clinical Assessment, Care Planning & Interdisciplinary Care Team:

• Provide RN Care Management to members with mental health, substance use, intellectual and/or developmental disability, co-occurring disorders and/or chronic medical conditions.
• This position serves members of all ages as well as their families and service providers in order to link them with appropriate services and resources.
• Care Management can involve a wide range of scenarios which require a wide array of potential responses including micro and macro level interventions.
• These may include, but are not limited to: assessment, care monitoring, and care planning, member and family education, medication reconciliation, consultation, researching, reviewing documentation, phone communication, attendance at treatment team meetings, and consultation.
• Timely and complete documentation regarding member specific interactions is required.
• Focused attention will be given to members with Medicaid with acute risk stratification levels and any other High Risk/High Cost populations.

Collaboration and Consultation:

• The nurse on this team may, assess health literacy, provide member and family education,
• Facilitate member visits when appropriate.
• Partner with Care Management on member home visits, as needed.
• Be a consultative resource for other Vaya Care Management Team Members.

Research, Member and Department Education:

• Staff development, development of group education and identification of Best Practices for specific patient conditions.
• RN provides member resources through identifying and analyzing community resources, research medical and dental services available.
• May also conduct Population Disease Research, assist in prioritization of complex conditions, assist when needed in development of member Care Plan, be a liaison for other medical teams on development of partnership for non-emergent patient care and patient education.
• Serve as a resource to Vaya Care Management staff and provide trainings related to medical and MHDDSU as requested.

Performs other related tasks as required:

• Attend agency staff/department meetings as appropriate.
• Receive continuing education training as necessary to maintain licensure.
• Other duties as required for role.

KNOWLEDGE OF JOB

• Utilizes all aspects of the Nursing Process.
• Appropriately documents and communicates all required information in accordance with agency policies and procedures, accreditation, regulation, and legal requirements.
• Thorough knowledge of community-based programs and eligibility criteria pertaining to Intellectual and/or Developmental Disability, mental health and substance abuse programs;
• Thorough knowledge of the policies and practices of case management; skill in dealing with consumers and their families in a tactful manner;
• Proficient skill in the use of personal computers, related software applications, hardware and peripheral equipment;
• Ability to express ideas clearly/concisely
• Ability to maintain accurate records and files;
• Represent Vaya in a professional manner
• An ability to initiate and build relationships with people in an open, friendly, and accepting manner
• Strong attention to detail and superior organizational skills
• Ability to communicate ideas effectively in both oral and written formats; ability to maintain the confidentiality of consumers;
• Ability to establish effective working relationships with associates, consumers, their families, social workers and the general public.
• Ability to travel and work with consumers and their families in both office based and home settings. Have highly effective communication
• Knowledge in Vaya Medicaid B and C Waivers, NC Innovations Waiver, and accreditations and apply this knowledge in problem-solving and responding to questions/inquiries
• Have a dynamic, proactive approach to assessment, screening, monitoring and coordination of care, to ensure quality supports and consistent adherence to waiver requirements
• Understand the following areas, in addition to other required trainings:
  • BH I/DD Tailored Plan eligibility and services
  • Whole-person health and unmet resource needs (ACEs, Trauma, cultural humility)
  • Community integration (Independent living skills; transition and diversion, supportive housing, employment, etc)
  • Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc)
  • Health promotion (Common physical comorbidities, self-management, use of IT, care planning, ongoing coordination)
  • Other care management skills (Transitional care management, motivational interviewing, Person-centered needs assessment and care planning, etc)
  • Serving members with I/DD or TBI (Understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc)
  • Serving children (Child- and family-centered teams, Understanding of the ‘System of Care‘ approach)
  • Serving pregnant and postpartum women with SUD or with SUD history
  • Serving members with LTSS needs (Coordinating with supported employment resources

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

QUALIFICATIONS & CREDENTIALING REQUIREMENTS

Associate Degree in Nursing with licensure as a Registered Nurse in North Carolina is required. Bachelor‘s degree in Nursing or other Human Service field preferred. Must also have the following:

• If serving members with behavioral health (BH) needs, must have two (2) years of experience working directly with individuals with BH conditions
• If serving members or recipients with an I/DD or Traumatic Brain Injury (TBI), must have two (2) years of experience working directly with individuals with I/DD or TBI
• If serving members with LTSS needs, must have the minimum requirements defined above and shall additionally have at a minimum two (2) years of prior Long-tern Services and Supports and/or Home Community Based Services coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working directly with individuals with BH conditions, an I/DD, or a TBI, described above

Experience in Medicaid Managed Care preferred.

Licensure/Certification Required:

Must be licensed as a Registered Nurse in North Carolina.

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENTS: The person in this position is required to reside in North Carolina or within 40 miles of the NC border.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open until filled.

APPLY: Vaya Health accepts online applications in our Career Center, please visit about/careers/ .

Vaya Health is an equal opportunity employer.