1915(i) Waiver Care Coordinator (Macon County)
Company: Vaya Health
Location: Franklin
Posted on: May 6, 2024
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Job Description:
LOCATION: Remote - must live in or near Macon County, NC
GENERAL STATEMENT OF JOBThe 1915(i) Waiver Care Coordinator ("Care
Coordinator") is responsible for providing proactive intervention
and coordination of care to eligible Vaya Health members and
recipients ("members") to ensure that these individuals receive
appropriate assessment and services. Care Coordinator is also
responsible for providing care coordination activities and
monitoring to individuals who have been deemed eligible for 1915i
services by North Carolina Department of Health and Human Services
(DHHS). Care Coordinator works with the member and care team to
alleviate inappropriate levels of care or care gaps, coordinate
multidisciplinary team care planning, linkage and/or coordination
of services across the 1915i service array and other healthcare
network(s) including the MH, SU, intellectual/ developmental
disability ("I/DD"), traumatic brain injury ("TBI") physical
health, pharmacy, long-term services and supports ("LTSS") and
unmet health-related resource needs. Care Coordinator support and
may provide transition planning assistance to state, and community
hospitals and residential facilities and track individuals
discharged from facility settings to ensure they follow up with
aftercare services and receive needed assistance to prevent further
hospitalization. This is a mobile position with work done in a
variety of locations, including members' home communities. The Care
Coordinator also works with other Vaya staff, members, relatives,
caregivers/ natural supports, providers, and community
stakeholders. As further described below, essential job functions
of the Care Coordinator include, but may not be limited
to:Utilization of and proficiency with Vaya's Care Management
software platform/ administrative health record ("AHR")Outreach and
engagementCompliance with HIPAA requirements, including
Authorization for Release of Information ("ROI")
practicesPerforming NC Medicaid 1915i Assessment tool to gather
information on the member's relevant diagnosis, activities of daily
living, instrumental activities of daily living, social and
work-related needs, cognitive and behavioral needs, and services
the member is interested in receiving Adherence to Medication List
and Continuity of Care processesParticipation in interdisciplinary
care team meetings, comprehensive care planning, and ongoing care
managementTransitional Care ManagementDiversion from institutional
placement This position is required to meet NC Residency
requirements as defined by the NC Department of Health and Human
Services ("NCDHHS" or "Department"). ESSENTIAL JOB
FUNCTIONSAssessment, Care Planning and Interdisciplinary Care
Team:Ensures identification, assessment, and appropriate
person-centered care planning for members. Meets with members to
complete a standardized NC Medicaid 1915i Assessment Links members
with appropriate and necessary formal/ informal services and
supports across all health domains (i.e., medical, and behavioral
health home)Supports the care team in development of a
person-centered care plan ("Care Plan") to help define what is
important to members for their health and prioritize goals that
help them live the life they want in the community of their
choice.Ensure the Care Plan includes specific services, including
1915(i) services to address mental health, substance use or I/DD,
medical and social needs as well as personal goalsEnsure the Care
Plan includes all elements required by NCDHHSUse information
collected in the assessment process to learn about member's needs
and assist in care planningEnsure members of the care team are
involved in the assessment as indicated by the member/LRP and that
other available clinical information is reviewed and incorporated
into the assessment as necessaryWork with members to identify
barriers and help resolve dissatisfaction with services or
community-based interventionsReviews clinical assessments conducted
by providers and partners with licensed staff for clinical
consultation as needed to ensure all areas of the member's needs
are addressed. Help members refine and formulate treatment goals,
identifying interventions, measurements, and barriers to the
goalsEnsures that member/legally responsible person ("LRP") is/are
informed of available services, referral processes (e.g.,
requirements for specific service), etc.Provides information to
member/LRP regarding their choice of service providers, ensuring
objectivity in the processWorks in an integrated care team
including, but not limited to, an RN (Registered Nurse) and
pharmacist along with the member to address needs and goals in the
most effective way ensuring that member/LRP have the opportunity to
decide who they want involved Supports and may facilitate care team
meetings where member Care Plan is discussed and reviewedSolicits
input from the care team and monitors progressEnsures that the
assessment, Care Plan, and other relevant information is provided
to the care team Consults with care management licensed
professionals, care management supervisors, and other colleagues as
needed to support effective and appropriate member care/planning
process Support Monitoring/Coordination, Documentation and Fiscal
Accountability:Serves as a collaborative partner in identifying
system barriers through work with community stakeholders. Works in
partnership with other Vaya departments to identify and address
gaps in services/ access to care within Vaya's
catchment.Participates in cross-functional clinical and
non-clinical meetings and other projects as needed/ requested to
support the department and organization.Participates in routine
multidisciplinary huddles including RN, Pharmacist, M.D. to present
complex clinical case presentation and needs, providing support to
other CMs (Care Manager) and receiving support and feedback
regarding CM interventions for clients' medical, behavioral health,
intellectual /developmental disability, medication, and other
needs.Works with 1915 (i) Care Coordination manager in
participating in high-risk multidisciplinary complex case staffing
as needed to include Vaya CMO/ Deputy CMO, Utilization Management,
Provider Network, and Care Management leadership to address
barriers, identify need for specialized services to meet client
needs within or outside the current behavioral health system.Ensure
that services are monitored (including direct observation of
service delivery) in all settings at required frequency and for
compliance with standardsMonitors provision of services to
informally measure quality of care delivered by providers and
identify potential non-compliance with standards.Ensures the health
and safety of members receiving care management, recognize and
report critical incidents, and escalate concerns about health and
safety to care management leadership as needed.Supports
problem-solving and goal-oriented partnership with member/LRP,
providers, and other stakeholders.Promotes member satisfaction
through ongoing communication and timely follow-up on any
concerns/issues.Supports and assists members/families on services
and resources by using educational opportunities to present
information.Make announced/unannounced monitoring visits, including
nights/weekends as applicable. Promote satisfaction through ongoing
communication and timely follow-up on any concerns/issuesMonitor
services to ensure that they are delivered as outlined in
individualized service plan and address any deviations in
serviceVerifies member's continuing eligibility for Medicaid, and
proactively responds to a member's planned movement outside Vaya's
catchment area to ensure changes in their Medicaid county of
eligibility are addressed prior to any loss of service. Alerts
supervisor and other appropriate Vaya staff if there is a change in
member Medicaid eligibility/status. Maintain electronic health
record compliance/quality according to Vaya policyProactively
monitor own documentation to ensure that issues/errors are resolved
as quickly as possibleEnsure accurate/timely submission of Service
Authorization Requests (SARS) for all Vaya funded
services/supportsProactively monitors own documentation within the
AHR to ensure completeness, accuracy and follow through on care
management tasks.Works with 1915 (i) Care Coordination Manager to
ensure all clinical and non-clinical documentation (e.g., goals,
plans, progress notes, etc.) meet all applicable federal, state,
and Vaya requirements, including requirements within Vaya's
contracts with NCDHHS.Participates in all required Vaya/ Care
Management trainings and maintains all required training
proficiencies. Other duties as assigned. KNOWLEDGE, SKILL &
ABILITIES:Ability to express ideas clearly/concisely and
communicate in a highly effective mannerAbility to drive and sit
for extended periods of time (including in rural areas)Effective
interpersonal skills and ability to represent Vaya in a
professional mannerAbility to initiate and build relationships with
people in an open, friendly, and accepting mannerAttention to
detail and satisfactory organizational skillsAbility to make prompt
independent decisions based upon relevant facts.A result and
success-oriented mentality, conveying a sense of urgency and
driving issues to closureComfort with adapting and adjusting to
multiple demands, shifting priorities, ambiguity, and rapid
changeThorough knowledge of standard office practices, procedures,
equipment, and techniques and intermediate to advanced proficiency
in Microsoft office products (Word, Excel, Power Point, Outlook,
Teams, etc.), and Vaya systems, to include the care management
platform, data analysis, and secondary researchUnderstanding of the
Diagnostic and Statistical Manual of Mental Disorders (current
version) within their scope and have considerable knowledge of the
MH/SU/IDD/TBI service array provided through the network of Vaya
providers. Experience and knowledge of the NC Medicaid program, NC
Medicaid Transformation, Tailored Plans, state-funded services, and
accreditation requirements are preferred.Ability to complete and
maintain all trainings and proficiencies required by Vaya, however
delivered, including but not limited to the following:BH I/DD
Tailored Plan eligibility and servicesWhole-person health and unmet
resource needs (Adverse Childhood Experiences, 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 Substance Use Disorder (SUD) or with SUD historyServing
members with LTSS needs (Coordinating with supported employment
resources)Job functions with higher consequences of error may be
identified, and proficiency demonstrated and measured through job
simulation exercises administered by the supervisor where a minimum
threshold is required of the position. QUALIFICATIONS & EDUCATION
REQUIREMENTSBachelor's degree in a field related to health,
psychology, sociology, social work, nursing or another relevant
human services area is preferred. Required years of work experience
(include any required experience in a specific industry or field of
study):Serving members with BH conditions:Two (2) years of
experience working directly with individuals with BH
conditionsServing members or recipients with an I/DD or Traumatic
Brain Injury (TBI)Two (2) years of experience working directly with
individuals with I/DD or TBIServing members with LTSS needsMinimum
requirements defined aboveTwo (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 OR a combination of education and experience
as follows:A graduate of a college or university with a Bachelor's
degree in a human services field and two years of full-time
accumulated experience with population servedORA graduate of a
college or university with a Bachelor's degree is in field other
than Human Services and four years of full-time accumulated
experience with population servedORA graduate of a college or
university with a Bachelor's Degree in Nursing and licensed as RN,
and four years of full-time accumulated experience with population
served. Experience can be before or after obtaining RN
licensure.ORPlease note, if a graduate of a college or university
with a Master's level degree in Human Services, although only one
year is needed to reach QP status, the incumbent must still have at
least two years of experience with the population served *Must meet
the criteria of being a North Carolina Qualified Professional with
the population served in 10A NCAC 27G .0104 Licensure/Certification
Required:If Bachelor's degree in nursing and RN, incumbent must be
licensed to practice in the State of North Carolina by the North
Carolina Board of Nursing. 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. Ability to drive and sit for
extended periods of time (including in rural areas)
RESIDENCY REQUIREMENT:This position is required to reside in North
Carolina or within 40 miles of the North Carolina border. SALARY:
Depending on qualifications & experience of candidate. This
position is non-exempt and is eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health
accepts online applications in our Career Center, please visit .
Vaya Health is an equal opportunity employer.
Keywords: Vaya Health, Charlotte , 1915(i) Waiver Care Coordinator (Macon County), Other , Franklin, North Carolina
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