TCM Care Manager

Role Overview

• Conduct comprehensive assessments at enrollment, yearly, or during changes in condition.
• Develop, update, and facilitate Care Plans derived from these assessments.
• Utilize person-centered planning, motivational interviewing, and historical review of assessments to identify required supports.
• Address Social Determinants of Health (SDOH), disparities, and complex payer issues in the Plan of Care.
• Assign interventions/plans of care to Extenders for monitoring and service engagement.
• Coordinate with team members for smooth transitions to appropriate levels of care.
• Participate in the agency’s twenty-four (24) hour coverage for care management.
• Educate members/Legally Responsible Persons (LRP) about care teams, services, rights, the grievance and appeals process, available service options, and payer requirements.
• Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.
• Ensure adherence to service orders/doctor’s orders and obtain necessary releases/documentation.
• Submit necessary documentation to the payer for timely service delivery.
• Maintain all certifications or licensure required for the position and comply with all agency policies and procedures.
• Evaluate the appropriateness of services and ensure the implementation of the plan of care through regular assessments.
• Escalate complex cases to the Supervisor and report critical incidents.
• Attend Behavior Support Plan (BSP) meetings.
• Assist individuals/LRP in choosing service providers, ensuring objectivity.
• Utilize Admission, Discharge, and Transfer (ADT) information to support members admitted, transferred, or discharged from a facility promptly.
• Collaborate with the care team and service providers to develop plans reflecting the individual’s needs and desired life goals.
• Complete all other responsibilities as assigned by the supervisor.
• Visiting members at their living arrangements, such as their own home, a relative's home, a care facility, or any other location, is essential and required to ensure the delivery of high-quality care.

Requirements

• A Bachelor’s degree 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 years of experience working directly with individuals with behavioral health conditions, I/DD or TBI condition(s)
• For Care managers serving members with LTSS needs: two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
• Proficiency in Person-Centered Thinking/planning
• Experience using assessments to develop plans of care
• Knowledge of LOC processes
• Familiarity with Medicaid basic, enhanced MHSUD, and waiver benefits plans
• Proficiency in using Motivational Interviewing techniques
• Strong interpersonal and written/verbal communication skills
• Conflict management and resolution skills
• Proficiency in Microsoft Office products
• Ability to make prompt, independent decisions
• Good organizational skills to prioritize duties and meet deadlines.

Benefits

• Flexible work arrangements