I/DD Care Manager – QP

🔥 2 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $54k - $70.2k / year

⏰ Full Time

🟢 Junior

👔 Manager

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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 intellectual and developmental disabilities (I/DD) • Secure and coordinate physical health, developmental disability, behavioral health, and long-term services and supports • Conduct comprehensive assessments 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 monitor compliance with state standards and Medicaid regulations • Verify service delivery and address deviations • Educate members and families on self-management, self-advocacy, rights, protections, responsibilities, and available services • Promote culturally competent services and supports • 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 identification 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 applications, renewals, and required documentation • Provide time-limited care coordination and transitional care management for members excluded from Tailored Care Management • Participate in weekly conferences with CCNC as needed and coordinate with other care management entities • Assist state-funded recipients with Medicaid applications and coordinate Medicaid deductibles • Monitor documentation and billing and resolve issues/errors • Ensure clinical documentation and medical records meet state, agency, and Medicaid requirements • Recognize and report critical incidents • Promote member satisfaction through communication and timely follow-up • Collaborate with providers on authorization requests for Tailored Plan-funded services • Document grievances and concerns in the grievance system • Provide leadership, communication, and direction to each member’s care team

🎯 Requirements

• Must reside in North Carolina or within 40 miles of the North Carolina border • Must be able to travel regularly as needed to perform job duties • Bachelor’s degree in a health-related, psychology, sociology, social work, nursing, or other 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 RN licensure 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 I/DD experience • 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 and communication skills; 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, families, 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/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 to and knowledge of different cultures, ethnicities, spiritual beliefs, and sexual orientation • If a Registered Nurse, must be licensed in North Carolina • Ability to drive and sit for extended periods, including in rural areas

🏖️ Benefits

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

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