TCM Care Manager - Trillium Catchment Area

Healthkeeperz LLC; Wilmington (NC); Hybrid; USD 60,000 - 75,000; Full time

Job summary

A healthcare service provider is seeking a Care Manager to deliver comprehensive care management for individuals with behavioral health needs. This position involves assessments, care planning, coordination of services, and ensuring customer satisfaction. Qualified candidates should hold a relevant Bachelor's degree and have at least two years of experience with behavioral health or related conditions. The role offers a hybrid work option, combining remote flexibility with essential in-person visits.

Qualifications

• Two years of experience with behavioral health conditions or I/DD.
• Experience in LTSS and/or HCBS coordination for Care Managers serving LTSS needs.

Responsibilities

• Conduct comprehensive assessments at enrollment and annually.
• Develop and facilitate Care Plans based on assessments.
• Coordinate with team members for effective transitions of care.

Skills

Proficiency in Person-Centered Thinking/planning

Strong interpersonal and written/verbal communication skills

Proficiency in Microsoft Office products

Conflict management and resolution skills

Education

Bachelor’s degree in a relevant field or RN licensure

Job description

Description

Position: Care Manager

Department: Tailored Care Management

Remote Work Position: Hybrid/Remote

Location: Trillium Catchment Area (We are filling multiple slots for this position)

Reports To: Tailored Care Management Supervisor

Scope of Work Summary

The Care Manager is part of a multidisciplinary care team providing whole-person care management for Behavioral Health I/DD Tailored Plan beneficiaries. The role spans multiple domains, including physical health, behavioral health, I/DD, traumatic brain injury (TBI), pharmacy, long-term services and supports (LTSS), and unmet health-related resource needs.

Expectations

Assessment and Care Planning

• 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.

Coordination and Support

• Assign interventions/plans of care to Extenders [KO1] [JC2] 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.

Education and Customer Service

• 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.

Compliance and Documentation

• 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.

Risk Management

• 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.

Additional Duties

• 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.

Service Type and Program Requirements

• 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

Requirements

Education/Certifications

• 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.

Physical Demands

The above statements describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required for the position. This position also requires standing, sitting, walking, lifting, and other physical activities for extended periods, including driving. All employees may have other duties assigned at any time.