Innovations Care Manager

6 days ago

Gastonia, United States Partners Health Alliance Full time
**This is a mobile position which will work primarily out in the assigned communities.**

Competitive Compensation & Benefits Package
Position eligible for -
  • Annual incentive bonus plan
  • Medical, dental, and vision insurance with low deductible/low cost health plan
  • Generous vacation and sick time accrual
  • 12 paid holidays
  • State Retirement (pension plan)
  • 401(k) Plan with employer match
  • Company paid life and disability insurance
  • Wellness Programs
See attachment for additional details.

Office Location: Mobile position; Available for Gaston county, NC

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of Position:

The Innovations Care Manager is responsible for providing Tailored Care Management for members with intellectual/developmental disabilities enrolled in the NC Innovations waiver. The Innovations Care Manager is responsible for addressing members' whole-person needs alongside coordinating and monitoring their waiver services. The Innovations Care Manager actively engages with members through comprehensive assessment, care planning, health promotion, and comprehensive transitional care. If members enrolled in the waiver opt out of Tailored Care Management, the member will remain enrolled in the waiver and the Care Manager will provide Care Coordination to monitor and coordinate waiver services. Travel is an essential function of this position.

Role and Responsibilities:

Duties of the Innovations Care Manager include, but are not limited to, the following:

Comprehensive Care Management
  • Provide assessment and care management services aimed at the integration of primary, behavioral and specialty health care, and community support services, using a comprehensive person-centered care plan which addresses all clinical and non-clinical needs and promotes wellness and management of chronic conditions in pursuit of optimal health outcomes
  • Complete a care management comprehensive assessment within required timelines and update as needed
  • Develop a comprehensive Individual Support Plan and update as needed
  • Ensure that the member/legally responsible person (LRP) and all others responsible for plan implementation sign the plan and updates
  • Educate members/LRP on methodology for budget development, total dollar value of the budget and mechanisms available to modify the member budget.
  • Educate the member/LRP on waiver requirements/limits, however, ensures services, as requested are outlined in the budget.
  • Secure service authorizations for all Innovations waiver services
  • Ensures that service orders/doctor's orders are obtained, as applicable
  • Provide diversion activities to support community tenure
  • Monitor services based on Innovations Waiver, Home and Community Based Standards and Tailored Plan requirements
Care Coordination
  • Facilitate access to and the monitoring of services identified in the Individual Support Plan to manage chronic conditions for optimal health outcomes and to promote wellness.
  • Facilitate communication and regularly scheduled interdisciplinary team meetings to review care plans and assess progress.
  • Make announced/unannounced monitoring visits, including nights/weekends as applicable
  • Monitor services for compliance with state standards, waiver requirements, and Medicaid regulations, as applicable
  • Monitor to ensure that any restrictive interventions (including protective devices used for behavioral support) are written into the ISP and the Positive Behavior Support Plan
  • Verify that services are delivered as outlined in person centered plan and addresses any deviations in services
  • Notify Utilization Management of any suspected or actual changes in level of care
  • Monitor compliance with home and community-based standards
Individual and Family Supports
  • Provide education and guidance on self-management and self-advocacy
  • Provide information to the member about the member's rights, protections, and responsibilities, including the right to change providers, the grievance and complaint resolution process, and fair hearing processes
  • Help members make informed choices of care team participants, provide information about providers, and arrange provider interviews as needed
Health Promotion
  • Educate and engage the member and member's caregivers in making decisions that promote his/her maximum independent living skills, good health, pro-active management of chronic conditions, early identification of risk factors, and appropriate screening for emerging health problems
Transitional Care Management
  • Facilitation of services for the member and family/caregiver when the member is experiencing care transitions (including, but not limited to transitions related to hospitalization, nursing facility, rehabilitation facility, community-based group home, etc.), significant life changes including, but not limited to loss of primary caregiver, transition from school services, etc.) or when a member is transitioning between health plans.
  • Create and implement a 90-day transition plan as an amendment to the member's ISP that outlines how the member will maintain or access needed services and supports, transition to the new care setting, and integrate into his or her community.
  • Proactively responds to a member's planned movement outside the LME/MCO geographic area to ensure changes in their Medicaid County of eligibility are addressed prior to any loss of service
Referral to Community/Social Supports
  • Provide information and assistance in referring members to community-based resources and social support services, regardless of funding source, which can meet identified needs
  • Provide comprehensive assistance securing health-related services, including assistance with initial application and renewal with filling out and submitting applications and gathering and submitting required documentation, including in-person assistance when it is the most efficient and effective approach
Other:
  • Verify member's continuing eligibility for Medicaid with Indicators and promptly follows-up on identified issues, as indicated
  • Coordinate Medicaid deductibles, as applicable, with the member/legally responsible person and provider(s)
  • Proactively monitor own documentation/billing to ensure that issues/errors are resolved as quickly as possible
  • Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements
  • Maintain medical record compliance/quality, as demonstrated by ≥90% compliance on Qualitative Record Reviews
  • Document within the grievance system any expression of dissatisfaction/concern expressed by members supported or others on behalf of the member supported
  • Ensure strong leadership to care team, including effectively communicating with and providing direction to Care Management extenders
Knowledge, Skills and Abilities:
  • Demonstrated knowledge of the assessment and treatment of I/DD needs, with or without co-occurring physical health, mental health or substance use disorder needs
  • Ability to develop strong, person-centered plans
  • Exceptional interpersonal skills, highly effective written and oral communication skills, and the propensity to make prompt independent decisions based upon relevant facts and established processes
  • Demonstrated ability to collaborate and communicate effectively in team environment
  • Ability to maintain effective and professional relationships with members, family members and other members of the care team
  • Problem solving, negotiation and conflict resolution skills
  • Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
  • Detail oriented
  • Ability to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiries
  • Ability to independently organize multiple tasks and priorities and to effectively complete duties within assigned timeframes
  • Ability to manage and uphold integrity and confidentiality of sensitive data
  • Sensitivity and knowledge of different cultures, ethnicities, spiritual beliefs and sexual orientation.
Education and Experience Required:
  • Bachelor's degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area and two (2) years of full-time experience with I/DD population OR
  • Bachelor's degree in a field other than human services and four (4) years of full-time experience with I/DD population OR
  • Master's degree in human services and one (1) year of full-time experience with I/DD population OR
  • Licensure as a registered nurse (RN) and four (4) years of full-time accumulated experience with I/DD
AND
  • Two (2) years of prior Long-Term Services and Supports (LTSS) and/or Home and Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working with I/DD population described above
AND
  • Must reside in North Carolina or within 40 miles of the NC border
  • Must have ability to travel regularly as needed to perform job duties


Education/Experience Preferred:

Experience working with members with co-occurring physical health and/or behavioral health needs preferred.

Licensure/Certification Requirements:

If a Registered Nurse (RN), must be licensed in North Carolina.

  • RN Unit Manager

    4 weeks ago

    Gastonia, United States Belaire Health Care Center Full time

    $5000 sign on bonus.Belaire Health Care Center has an exciting opportunity for a Unit Manager, RN in our 80bed skilled rehab center in Gastonia. The Unit Manager will oversee clinical operations of the unit and is responsible for staff supervision of nurses and CNAs, as well as interfacing with physicians, QI reporting and follow-up, and providing clinical...

  • Dialysis Clinical Manager Registered Nurse RN

    2 months ago

    Gastonia, United States Fresenius Medical Care Full time

    About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease...

  • Dialysis Clinical Manager Registered Nurse

    4 weeks ago

    Gastonia, United States Fresenius Medical Care Full time

    About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease...

  • Primary Care Physician

    3 weeks ago

    Gastonia, United States Oak Street Health Full time

    Description Title: Primary Care Physician Location:   South Carolina Region -  Openings in Birmingham, Charlotte, Columbia, Spartanburg, Gastonia, and Rock Hill. For a list of all applicable centers, see /locations Role Description: The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based...

  • Registered Nurse

    3 days ago

    Gastonia, United States BAYADA Home Health Care Full time

    Sign on Bonuses Available for Full Time Commitment BAYADA Home Health is looking for a compassionate and dedicated Registered Nurse (RN) to join our Charlotte Visits team as a Certified Wound Care Nurse (CWCN) or (CWOCN). This office services our adult and geriatric clients on a per visit basis in territories throughout Mecklenburg and Union counties. BAYADA...

  • Certified Nursing Assistant

    1 month ago

    Gastonia, United States BAYADA Home Health Care Full time

    BAYADA Home Health Care has an immediate need for a CNA - Certified Nursing Assistant to care for our clients. As a member of our home care team, you will be valued, respected, and heard. We have current job openings in the following locations: Monroe, Charlotte, Matthews and Mint Hill BAYADA offers CNAs: Weekly pay Flexible scheduling to fit your...

  • Certified Nursing Assistant

    4 weeks ago

    Gastonia, United States BAYADA Home Health Care Full time

    BAYADA Home Health Care has an immediate need for a CNA - Certified Nursing Assistant to care for our clients. As a member of our home care team, you will be valued, respected, and heard. We have current job openings in the following locations: Monroe, Charlotte, Matthews and Mint Hill BAYADA offers CNAs: Weekly pay Flexible scheduling to fit your...

  • Population Health Acute Care Manager

    4 weeks ago

    Gastonia, United States Kintegra Health Full time

    Job DescriptionJob DescriptionJob InformationTitle: Acute Care ManagerDepartment: Population Health and Case ManagementStatus: Hourly Location: Clinical Site (Varies)Reports To: Population Health and Case Management ManagerDirect Reports: None Summary of Position Under the direct supervision of the Population Health Manager, this person works...

  • Population Health Acute Care Manager

    4 weeks ago

    Gastonia, United States Kintegra Health Full time

    Job DescriptionJob DescriptionJob InformationTitle: Acute Care ManagerDepartment: Population Health and Case ManagementStatus: Hourly Location: Clinical Site (Varies)Reports To: Population Health and Case Management ManagerDirect Reports: None Summary of Position Under the direct supervision of the Population Health Manager, this person works...

  • Population Health Acute Care Manager

    3 weeks ago

    Gastonia, United States Kintegra Health Full time

    Job DescriptionJob DescriptionJob InformationTitle: Acute Care ManagerDepartment: Population Health and Case ManagementStatus: Hourly Location: Clinical Site (Varies)Reports To: Population Health and Case Management ManagerDirect Reports: None Summary of Position Under the direct supervision of the Population Health Manager, this person works...

  • Population Health Acute Care Manager

    2 weeks ago

    Gastonia, United States Kintegra Health Full time

    Job DescriptionJob DescriptionJob InformationTitle: Acute Care ManagerDepartment: Population Health and Case ManagementStatus: Hourly Location: Clinical Site (Varies)Reports To: Population Health and Case Management ManagerDirect Reports: None Summary of Position Under the direct supervision of the Population Health Manager, this person works...

  • Home Care Business Development Manager

    3 weeks ago

    Gastonia, United States ComForcare Full time

    Benefits: Bonus based on performance Competitive salary Flexible schedule Opportunity for advancement Profit sharing Training & development Live your best life possible by helping others live theirs. At ComForCare, we like to celebrate successes and have fun while building meaningful relationships. Join our team and be a part of a certified ! We don't like...

  • Operating Room Manager

    2 weeks ago

    Gastonia, United States Continuum Medical Staffing Full time

    Job DescriptionJob DescriptionOR Manager needed to support hospital system in Gastonia, NC. '..The Clinical Manager directs operations of the clinical area, clinical outcomes, customer satisfaction, marketing, customer experience and fiduciary responsibilities, of one or more units. Is accountable for delivery of high-quality services, optimal...

  • Population Health Transitional Care Management Navigator

    4 days ago

    Gastonia, United States Kintegra Health Full time

    Job DescriptionJob DescriptionTitle: Population Health Transitional Care Management NavigatorDepartment: Population Health & Case ManagementStatus: HourlyPosition: Classification/Category: ClinicalLocation: Coverage & Support for All Medical SitesReports To: Population Health ManagerDirect Reports: NoneSummary of Position: The Population Health Transitional...

  • Population Health Transitional Care Management Navigator

    4 weeks ago

    Gastonia, United States Kintegra Health Full time

    Job DescriptionJob DescriptionTitle: Population Health Transitional Care Management NavigatorDepartment: Population Health & Case ManagementStatus: HourlyPosition: Classification/Category: ClinicalLocation: Coverage & Support for All Medical SitesReports To: Population Health ManagerDirect Reports: NoneSummary of Position: The Population Health Transitional...

  • Warehouse Manager

    4 weeks ago

    Gastonia, United States Sika Full time

    Job DescriptionJob DescriptionCompany DescriptionWith over 100 years of experience, Sika is a worldwide innovation and sustainability leader in the development and production of systems and products for commercial and residential construction, as well as the marine, automotive, and renewable energy manufacturing industries. Sika has offices in over 100...

  • Program Manager

    4 weeks ago

    Gastonia, United States Sika Full time

    Job DescriptionJob DescriptionCompany DescriptionWith over 100 years of experience, Sika is a worldwide innovation and sustainability leader in the development and production of systems and products for commercial and residential construction, as well as the marine, automotive, and renewable energy manufacturing industries. Sika has offices in over 100...

  • Engineering Project Manager

    2 weeks ago

    Gastonia, United States Actalent Full time

    Description: - Responsibilities range from concept through commissioning - Develop and review estimates and schedules, and progress reports - Develop and review specifications, including design and construction criteria - Participate in activities associated with equipment and material procurement, permitting, and subcontracting - Perform and check...

  • Engineering Project Manager

    4 weeks ago

    Gastonia, United States Actalent Full time

    Description: - Responsibilities range from concept through commissioning - Develop and review estimates and schedules, and progress reports - Develop and review specifications, including design and construction criteria - Participate in activities associated with equipment and material procurement, permitting, and subcontracting - Perform and check...

  • Hospice Registered Nurse

    1 week ago

    Gastonia, United States Hospice & Palliative Care Charlotte Region Full time

    Job Details Job Location Gaston County - Gastonia, NCPosition Type Full TimeEducation Level 2 Year DegreeTravel Percentage Up to 50% Job Shift DayJob Category Nurse Description VIA Health Partners  is an industry leader and top-10 nationally ranked provider of end-of-life care. More importantly we are proud to be a community based, not for...