I/DD Care Manager – QP

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $54k - $70.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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• Jobs at this company usually fill in 38 days.

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Partners Health Management

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2012

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance • Health Care

Partners Health Management is a local management entity and managed care organization that focuses on providing essential mental health services, supports for individuals with intellectual and developmental disabilities, and substance use disorder services. Their mission is to assist members and their families in accessing the necessary care and resources to improve their overall well-being and integration into the community.

📋 Description

• Provide Tailored Care Management and/or care coordination to members/recipients with I/DD • Help secure and coordinate physical health, developmental disability, behavioral health, and LTSS services • Engage members/recipients through comprehensive assessment, care planning, health promotion, and transitional care • Complete comprehensive care management and health risk assessments within required timelines • Develop and update comprehensive Care Plans/Individual Support Plans • Provide diversion activities supporting community tenure • Facilitate access to and monitor services identified in care plans • Facilitate interdisciplinary team meetings and assess member progress • Monitor services for compliance with state standards, Medicaid regulations, and home- and community-based standards • Verify service delivery and address deviations • Educate members and families about self-management, self-advocacy, rights, protections, responsibilities, service options, and complaint processes • Educate members about I/DD waitlists and make referrals as indicated • Use person-centered planning methods to understand supported members • Promote prevention, health, independent living skills, chronic-condition management, and appropriate screening • Coordinate care with I/DD, behavioral health, and physical health providers, including in-person visits to emergency departments and skilled nursing facilities • Support medication management, treatment adherence monitoring, and monitoring of side effects and effectiveness • Manage transitions involving hospitals, nursing facilities, rehabilitation facilities, group homes, significant life changes, or health-plan changes • Create and implement 90-day transition plans • Refer members to community resources and social support services • Assist with health-related service applications, renewals, documentation, and submissions • Coordinate with other care-management entities and share assessments and care plans • Participate in weekly conferences with CCNC as needed • Assist state-funded recipients with Medicaid applications • Coordinate Medicaid deductibles where applicable • Monitor documentation and billing and resolve issues • Ensure clinical documentation meets state, agency, and Medicaid requirements • Maintain medical-record compliance and quality at or above 90% on Qualitative Record Reviews • Recognize and report critical incidents • Promote member satisfaction through communication and timely follow-up • Collaborate with providers on authorization requests for Tailor Plan-funded services • Document member concerns in the grievance system • Provide leadership, communication, and direction to the care team and Care Management extenders

🎯 Requirements

• Must live in or near Forsyth County, North Carolina • Must maintain residency in North Carolina or within 40 miles of the North Carolina border • Ability to travel regularly as needed to perform job duties • Bachelor’s degree in a health, psychology, sociology, social work, nursing, or another relevant human services field and two years of full-time experience with the I/DD population, OR bachelor’s degree in another field and four years of full-time experience with the I/DD population, OR master’s degree in human services and one year of full-time experience with the I/DD population, OR licensure as a registered nurse (RN) and four years of full-time accumulated experience with I/DD • Two 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 may be concurrent with the I/DD experience • If a Registered Nurse (RN), must be licensed in North Carolina • Demonstrated knowledge of 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 and highly effective communication ability • Ability to make prompt independent decisions based on relevant facts and established processes • Ability to collaborate and communicate effectively in a team environment • Ability to maintain effective professional relationships with members/recipients, family members, and care team members • Problem-solving, negotiation, and conflict-resolution skills • Excellent computer skills, including proficiency in Microsoft Office products such as Word, Excel, and Outlook • Ability to learn and apply legal, waiver, and program practices and requirements • Ability to organize multiple tasks and priorities and complete duties within assigned timeframes • Ability to manage and uphold the integrity and confidentiality of sensitive data • Sensitivity and knowledge of different cultures, ethnicities, spiritual beliefs, and sexual orientation • Close visual acuity, ability to perform physical activities including crouching, reaching, walking, talking, hearing, and repetitive hand, wrist, and finger motion • Ability to lift up to 10 pounds, sit for extended periods, and drive for extended periods, including in rural areas

🏖️ Benefits

• Non-exempt position eligible for overtime compensation • Equal opportunity employer

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