About this role
Role Overview
- Ensure the provision of Person-Centered Planning for all service delivery.
- Conducts outreach and engagement activities to engage members in care management.
- Conducts comprehensive assessment and reassessments within the required timeframes for acuity level of member.
- Facilitates the completion of the care plan, as well as ISP for Innovation Waiver services for members receiving waiver services, inclusive of crisis and safety plan.
- Makes referrals to community resources for primary and specialty medical care, physical well-being, mental health.
- Monitor notification of admissions and discharges of ER and hospitalizations.
- Coordinate members’ medication reviews and reconciliation.
- Facilitate proactive planning for transitional care support (pre-discharge).
Requirements
- A bachelor’s degree from an accredited college or university in a field related to health, psychology, sociology, social work, nursing or another relevant human services area, or licensure as a registered nurse (RN).
- Two (2) years of experience working directly with individuals with an I/DD.
- Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
- Must have a valid North Carolina driver’s license and be insurable by the agency’s insurance carrier.
- Knowledge and experience with NC Medicaid and Innovation Waiver.
- Excellent skills and proficiency in Microsoft Word, Google Suite, Excel, and navigating internet.
- Demonstrated skill with using Electronic Health Record and care management platforms.
- Ability to prepare clear, accurate and effective reports and other written materials.
- Ability to establish and maintain effective, collaborative relationships with internal staff, external stakeholders, and members.
Benefits
- Flexible work arrangements
- Professional development opportunities