clinical care manager

Affinity Health Management

<div><p><b>JOB DESCRIPTION SUMMARY</b></p>
<p>
The Clinical Care Coordinator provides administrative support to the Clinical Care team by managing the electronic medical records system. The Clinical Care Coordinator also supports administrative functions of the back office to include, but not limited to: billing, payroll, human resources and intake.</p>
<p>
The Clinical Care Coordinator offers training and ongoing support to new Clinical Care Coordinators.</p>
<p><b>
ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES</b></p>
<p>
1. Accurately enters a variety of data into various information systems</p>
<p>
2. Executes workflow functions in electronic medical record system</p>
<p>
3. Verifies accuracy of data entered through collaboration with Clinical Manager(s) and/or Clinical Director</p>
<p>
4. Manages incoming, outgoing and interoffice mail</p>
<p>
5. Provides customer support to patients and colleagues via phone, email and fax</p>
<p>
6. Alerts appropriate management team members regarding potential compliance issues.</p>
<p>
7. Maintains confidentiality of PHI and organization information at all times</p>
<p>
8. Order DME and alerts DME supplier when equipment is no longer in use/needs to be exchanged for other, etc.</p>
<p>
9. Participates and scribes IDG meetings</p>
<p>
10. Performs other specific projects relating to office procedures</p>
<p>
11. Provides training and ongoing support to new Clinical Care Coordinators within the region</p>
<p>
The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.</p>
<p><b>
POSITION QUALIFICATIONS</b></p>
<p>
1. High School Diploma (College Degree Preferred)</p>
<p>
2. At least two (2) years health care experience, preferably in hospice</p>
<p>
3. Demonstrates autonomy, organization, assertiveness, flexibility and cooperation in performing job responsibilities</p>
<p>
4. HCHB/Pointcare knowledge is preferred</p>
<p>
5. Proficient in MS Office and Google Applications</p></div>

Clinical Care Coordinator

UPMC

<div><div><p>UPMC Community Care Behavioral Health is hiring a full-time Precert Care Manager. This role will work Monday - Friday 3:30 pm - midnight with rotating weekends and holidays. Occasional overnight coverage may be needed at times. This role works fully remote and must reside within 2 hours of a CCBH office location. Candidate should reside within Pennsylvania or the tri-state area.
</p><p>A Precert Care Manager for the 24 hour precert team must be able and willing to work daylight, evening, and night shift positions that also rotate weekend and holiday coverage. A Precert Care Manager is responsible for documenting and reviewing clinical information and making authorization determinations for adult and child/adolescent members being referred to acute and non-ambulatory mental health and substance use disorder levels of care for all Community Care contracts. The Care Manager will also be responsible for crisis management and referring members to appropriate services based on triage assessment. The Care Manager executes these responsibilities consistent with the applicable Community Care Policies and Procedures. A care manager represents the organization to providers, member groups and families, and participates in the overall administration of clinical operations as warranted. A care manager is expected to bring a level of clinical leadership to the care management department. In addition, a care manager may serve as the care management lead for other members of his/her team.<br>
<br>
<b>Responsibilities:</b><br>
</p><ul><li>Coordinates, reviews, and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports to address member incidents, provider deficiencies, and quality of care concerns.</li><li>
Independently problem solves based on advanced-level knowledge of the service delivery system, clinical treatment, diversion resources, and the provider network for adult and child/adolescent members for behavioral health and SUD providers from the requested region, member services policies, members' rights and responsibilities, and the operating practices of the organization</li><li>
Responds to deadlines and has work completed on or before deadline 95% of the time.</li><li>
Identify need for and facilitate linkages for members and families between primary care and behavioral health providers and other social service or provider agencies to develop and coordinate service plans.</li><li>
Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services. Is able to provide members, providers and other stakeholders with accurate information concerning benefits and coverage.</li><li>
Demonstrates excellent clinical, written and oral communication skills.</li><li>
Utilizes supervision with team coordinator and clinical manager regularly.</li><li>
Assumes responsibility for completion of acute and non-ambulatory precerts and application of appropriate medical necessity guidelines. Precerts include adult and child/adolescent members from all Community Care being admitted to mental health and substance use disorder services, as well as afterhours/weekend completion of precerts for UPMC Health Plan Commercial and SNP lines of business.</li><li>
Assist with moving members to in network facilities or coordinating with appropriate Community Care contracts regarding approval for out of network service utilization.</li><li>
Consults with appropriate physician advisors as needed for case collaboration and care planning.</li><li>
Develops specific clinical interventions and coordinates with the assigned Community Care contract and care management team for members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care.</li><li>
Participates in professional development activities to further clinical skills and knowledge. Works as part of a team providing clinical expertise and knowledge to member services and other care management staff.</li><li>
Demonstrates advanced level of computer operation with electronic medical record systems and Microsoft Outlook, Word, and Excel Programs, as well as advanced typing proficiency.</li><li>
Receives and responds appropriately to complex calls, including Afterhours/Weekend Employee Assistance Program calls, triage calls, and provider or member complaints. Ensures accurate, thorough, and correct documentation of these calls.</li></ul></div><div><ul><li>
A current and unrestricted Pennsylvania Licensure in health or human services field (LSW, LCSW, LPC, LMFT) and master's degree OR licensed RN (BSN preferred)
</li><li>Minimum of three years of relevant clinical experience.
</li><li>Experience with both adult and child/adolescent populations and mental health and substance use disorder services strongly preferred.
</li><li>Experience in managed care strongly preferred.
</li><li>General knowledge of best practices in behavioral health, emphasizing work with special needs or priority populations and in public sector systems.
</li><li>Certification in substance use disorders helpful.
</li><li>PCPC 3rd Edition, ASAM, and Confidentiality Training preferred.
</li><li>Supervisory or other leadership experience in behavioral health also preferred<br>
<br>
<b>Licensure, Certifications, and Clearances:</b><br>
</li><li><p>Act 73 FBI
</p><p>Clearance
</p></li><p></p><li>Act 34 Criminal Clearance w Renewal
</li><li>Act 33 Child Clearance w Renewal
</li><li><p>Behavior Specialist OR Clinical Social Work OR Licensed Mar &amp; Fam Therapist OR Licensed Social Worker OR Professional Counselor OR Psychologist OR Registered Nurse
</p></li><p></p><li>Act 33 with renewal</li><li>
Act 34 with renewal</li><li>
Act 73 FBI Clearance with renewal</li><li>Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.</li></ul><br>
<b>
UPMC is an Equal Opportunity Employer/Disability/Veteran</b></div></div>

Precert Care Manager (Evening Shift)

Well care home health

<div>The Field Clinical Manager is responsible for the oversight of a clinical multi-disciplinary team, including the planning, controlling, organizing, and leading of the team in the provision of effective and efficient clinical services. The Field Clinical Manager supervises, supports, and educates staff at the point of service in the field. The Field Clinical Manager supports an efficient and accurate revenue cycle by enhancing the capture of appropriate revenue.
<h2 class="jobSectionHeader"><b>The Field Clinical Manager is responsible for the oversight of a clinical multi-disciplinary team, including the planning, controlling, organizing, and leading of the team in the provision of effective and efficient clinical services. The Field Clinical Manager supervises, supports, and educates staff at the point of service in the field. The Field Clinical Manager supports an efficient and accurate revenue cycle by enhancing the capture of appropriate revenue.
</b></h2><h3 class="jobSectionHeader"><b>PRIMARY JOB DUTIES
</b></h3><div><p>Oversees an interdisciplinary team which manages an active patient census as determined by the Director of Operations.
</p><p></p><p>Provides direct supervision of interdisciplinary team.
</p><p></p><p>Ensures effective utilization of team resources in patient care delivery that is quality oriented and cost efficient.
</p><p></p><p>Contributes to program effectiveness.
</p><p></p><p>Organizes and performs work effectively and efficiently.
</p><p></p><p>Maintains and promotes customer satisfaction.
</p></div><p></p><p><b>1.0 60% QUALITY OF WORK:
</b></p><p></p><p>1.1 30% Oversees an interdisciplinary team which manages an active patient census as evidenced by:
</p><ul><li>Oversees assignment of care, clinical integrity of practice, and flow of documentation through support of team members.
</li><li>Mentors competency in the areas of clinical assessment; competent OASIS gathering and interpretation; time management towards achieving efficient and effective care delivery; documentation at point-of-care; and team efficiency and operational support systems (Team Assistant and indirectly Medical Records staff).
</li><li>Builds and evaluates team members through hiring and firing responsibilities; mentoring and holding clinicians accountable to established agency standards of practice.
</li><li>Evaluates clinical competence in the area of practice through direct observation, skills assessment and performance appraisals, OASIS competency in the field practice and accurate documentation capture at the point of care.
</li><li>Collaborates with Workflow Clinical Manager, PI and Education coordinators regarding OASIS integrity, individual abilities, and deficits in documentation.
</li></ul><p></p><p>1.2 20% Provides direct supervision of an interdisciplinary team as evidenced by:
</p><ul><li>Directly supervises RNs, LPNs, PTs, PTAs, OTs, OTAs, SLPs, MSWs, HHAs, Team Assistants and indirect supervision of Medical Records Specialist.
</li><li>Ensures clinicians comply with and participate in mandated orientation, education, and weekly team meetings.
</li></ul><ul><li>Conducts supervisory visits in the field with clinical staff, ensures clinical compliance requirements are updated timely and submitted accordingly to applicable support departments.
</li></ul><p></p><p>1.3 10% Contributes to program effectiveness as evidenced by:
</p><ul><li>Participates actively in agency initiatives to develop new programs and improve existing programs.
</li><li>Facilitates agency growth through participation on a minimum of one standing home health committee.
</li><li>Actively participates in the design, implementation, and evaluation of at least one significant agency quality improvement project during each evaluation period.
</li><li>Completes OASIS integrity audits in the field as part of performance improvement incorporating results into performance appraisals.
</li><li>Communicates with the Director of Operations, advising of issues of concern, offering suggestions for improvement.
</li></ul><p></p><p><b>2.0 20% PRODUCTIVITY/USE OF TIME
</b></p><ul><li>Oversees compliance with timely submission of all documentation including 24-hour turnaround on ALL clinical documentation.
</li><li>Conducts performance reviews by agency due date.
</li><li>Maintains productivity of interdisciplinary team in concert with the Team Assistant.
</li><li>Responds to internal and external emails/voice mails within 2 hours.
</li><li>Utilizes counseling and appropriate disciplinary action when agency professional standards are violated.
</li><li>Creates a cohesive team with a focus on overall turnover.
</li><li>Facilitates clinical OASIS competency of team.
</li></ul><p></p><p><b>3.0 20% MISSION, VISION, VALUES
</b></p><p></p><p>3.1 10% Maintains and promotes customer satisfaction.
</p><ul><li>Abides by the confidentiality and ethics policies of Well Care Home Health.
</li></ul><ul><li>Promotes a cooperative, cohesive group process dedicated to provision of quality patient care with achievement of best possible outcomes.
</li><li>In situational leadership, demonstrates the ability to respond positively to changing circumstances to maximize opportunity or minimize potential problems.
</li><li>Working collaboratively and cooperating with all members of the agency.
</li></ul><p></p><p>3.2 10% Organizes and performs work effectively and efficiently as evidenced by:
</p><ul><li>Recognizing and performing duties in an independent manner.
</li><li>Accepting personal responsibility for the completion and quality of work outcomes.
</li><li>Utilizes available management data to monitor clinical operations efficiency.
</li><li>Presents a clean and neat appearance in personal attire and one&rsquo;s work area.
</li><li>Reports to work on time and returns promptly from errands, breaks and meals.
</li></ul><p></p><h2 class="jobSectionHeader"><b>JOB SPECIFICATIONS
</b></h2><div><p>Education: Graduate from an accredited or approved school of nursing or physical therapy. Bachelors degree preferred.
</p><p></p><p>Licensure / Certification: Current license to practice professional nursing or physical therapy in the State in which supervising staff/care (NC/SC).
</p><p></p><p>Experience: Minimum of two years clinical practice. Minimum one year home health experience preferred. Prior experiences that would encompass clinical, teaching, and supervisory practice within a nursing service organization is preferred.
</p><p></p><p>Essential Technical Skills: Current knowledge of fundamental medical-surgical and home health nursing principles and practice. Knowledge of the principles of adult learning. Knowledge of standards of medical record keeping. Ability to speak clearly and effectively before small and large groups. Ability to communicate, both orally and in writing, and to be literate in the English language.
</p><p></p><p>Interpersonal Skills: Excellent interpersonal skills including the ability to interact and communicate in a professional and tactful manner with coworkers, physicians, patients and families and the general public. Must be flexible and innovative.
</p><p></p><p>Essential Physical Requirements: Ability to stand or sit for extended periods of time when orienting/training. Requires ability to stoop or kneel, bend, push, reach with hands/arms when supervising-precepting staff in patient care activities or providing direct patient care.
</p><p></p><p>Essential Mental Requirements: Ability to coordinate resources of the agency. Ability to facilitate cooperation and communication among team members. Demonstrate long and short-term memory. High level problem solving and reasoning skills to assist staff in patient care planning and problem resolution. Able to prioritize duties, learn new skills and use supportive services appropriately. Must work well independently.
</p><p></p><p>Essential sensory requirements: Ability to use sight to assess, plan, implement and evaluate patient care activities. Ability to use hearing to communicate with staff.
</p><p></p><p>Exposure to Hazards: Noise, exposure to office equipment and machinery. Requires long periods of computer and chart review. Travel required. May encounter temperature changes and weather extremes.
</p><p></p><p>Other &ndash; Hours of Work: Monday &ndash; Friday, weekends and holidays as needed. Occasional need for flexible hours to meet educational needs of staff and the agency. Able to rotate call and respond to assist as needed while on call.
</p><p></p><p>Must have a valid North Carolina driver&rsquo;s license and an operational vehicle.</p></div></div>

Home Health Field Clinical Manager

HealthArc

<p><b>Job Summary</b><br/>We are seeking a compassionate, organized, and experienced Registered Nurse (RN) to join our care team as a Clinical Care Manager. This role combines patient-centered care with remote monitoring and chronic care management (RPM/CCM) and includes supervisory responsibility over a team of CMAs (Certified Medical Assistants / Medication Aides) and LPNs and RNs. The ideal candidate will ensure high-quality patient care, streamline care coordination, and lead a clinical support team to deliver efficient and safe patient services.<br/><b>Location: Remote (FL, GA, NJ, NY, OH, TX)</b></p><p><b>Key Responsibilities</b></p><ul><li>Lead a team of clinical personnel to provide the highest quality patient care</li><li>Monitor and review biometric and physiologic data (e.g. blood pressure, glucose, weight, heart rate, oxygen saturation, etc.) transmitted via RPM devices from patients&rsquo; homes.</li><li>Perform clinical assessments (telephonic or virtual) based on RPM data, identify alarming signals or concerning trends, and escalate care or intervene as appropriate and coach others on how to do this.</li><li>Provide patient education and coaching &mdash; explain device usage, help patients understand their health data, reinforce treatment plans, and encourage adherence.</li><li>Document all data, assessments, interventions, and communications accurately in electronic health records (EHR) or care-management software; ensure compliance with clinical and billing documentation requirements.</li></ul><p><b>Team Supervision &amp; Leadership (CMAs &amp; LPNs)</b></p><ul><li>Supervise and oversee the daily work of CMAs and LPNs assigned under your direction &mdash; assign shifts and duties to ensure adequate coverage and balanced workload.</li><li>Provide orientation, training, and ongoing education for CMAs/LPNs regarding care protocols, safety standards, documentation procedures, and scope-of-practice guidelines</li><li>Mentor and coach the team &mdash; offer clinical guidance, support decision-making, answer questions, and promote professional development of support staff.</li><li>Evaluate performance of team members, provide feedback, conduct performance reviews, and implement corrective actions or improvement plans when necessary.</li><li>Ensure that tasks assigned to CMAs/LPNs are within their legal scope of practice and follow appropriate delegation rules under RN supervision.</li><li>Monitor quality and consistency of care delivered &mdash; perform periodic audits, review documentation, and conduct rounds (in-person or virtual) to ensure safety and adherence to standards.</li><li>Manage staffing and scheduling &mdash; maintain adequate staffing levels per shift, adjust assignments based on patient acuity, leave or peak times, and ensure coverage for all necessary care services.</li><li>Serve as a liaison between the nursing/support staff and other healthcare professionals (physicians, specialists, therapists, social workers), ensuring proper communication, smooth handoffs, and coordination of care across disciplines.</li></ul><p><b>Care Coordination, Quality Assurance &amp; Program Management</b></p><ul><li>Oversee the overall care delivery process for patients under RPM/CCM and the clinical support team &mdash; ensuring care quality, patient safety, and regulatory compliance.</li><li>Participate in developing, implementing, and maintaining protocols, policies, and standard operating procedures (SOPs) for care delivery, remote monitoring, documentation, and care coordination.</li><li>Track clinical outcomes, readmissions, hospitalizations, patient satisfaction, and other relevant metrics; analyze trends and recommend quality improvement initiatives.</li><li>Facilitate patient and family education &mdash; teach about chronic disease management, self-care, medication adherence, use of RPM devices, lifestyle modifications, and health literacy.</li><li>All other assigned duties.</li></ul><p><b>Qualifications Required:</b></p><p>Active, unrestricted Registered Nurse (RN) license.</p><p>Knowoledge or remote care space and virtual care</p><p>Preferred:</p><p>BSN degree from an accredited institution</p><p>Minimum of 2&ndash;5 years of clinical nursing experience; prior exposure to case management, chronic care, telehealth, home-health.</p><p>Job Type: Full-time</p><p>Pay: $30.00 - $35.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Application Question(s):</p><ul><li>How many years of experience do you have in CCM and RPM?</li></ul><p>Experience:</p><ul><li>Registered Nurse: 4 years (Required)</li></ul><p>License/Certification:</p><ul><li>BSN degree (Preferred)</li></ul><p>Work Location: Remote</p>

Care Manager (Registered Nurse)

Vaya Health

<div><div><b>LOCATION:</b> Remote &ndash; must live in or near McDowell County, North Carolina. The person in this position is required to maintain residency in North Carolina or within 40 miles of the NC border. <i>This position requires travel</i>.</div><div></div><div><b><br>
GENERAL STATEMENT OF JOB</b></div><div>
The Care Manager Licensed Professional (&ldquo;Care Manager - LP&rdquo;) is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (&ldquo;members&rdquo;) to ensure that these individuals receive appropriate assessment and services. The Care Manager - LP works with the member and care team to identify and alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member across the MH, SU, intellectual/ developmental disability (&ldquo;I/DD&rdquo;), traumatic brain injury (&ldquo;TBI&rdquo;) physical health, pharmacy, long-term services and supports (&ldquo;LTSS&rdquo;) and unmet health-related resource needs networks. Care Manager - LP supports and may provide clinical 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&rsquo; home communities. The Care Manager - LP also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. <b>The Care Manager - LP also utilizes licensed clinical knowledge and skills to assess needs, inform care planning development, provide clinical consultation, and offer recommendations for appropriate care.</b></div><div></div><div><br>
As further described below, essential job functions of the Care Manager - LP includes, but may not be limited to:</div><ul><li>
Utilization of and proficiency with Vaya&rsquo;s Care Management software platform/ administrative health record (&ldquo;AHR&rdquo;)</li><li>
Outreach and engagement</li><li>
Compliance with HIPAA (Health Insurance Portability and Accountability) requirements, including Authorization for Release of Information (&ldquo;ROI&rdquo;) practices</li><li>
Performing Health Risk Assessments (HRA): a comprehensive bio-psycho-social assessment addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care</li><li>
Adherence to Medication List and Continuity of Care processes</li><li>
Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management</li><li>
Transitional Care Management</li><li>
Divers</li><li>
ion from institutional placement</li></ul><div></div><div><br>
This position is required to meet NC (North Carolina) Residency requirements as defined by the NC Department of Health and Human Services (&ldquo;NCDHHS&rdquo; or &ldquo;Department&rdquo;). This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams.</div><div></div><div><b><br>
ESSENTIAL JOB FUNCTIONS</b></div><div><b>
Clinical Assessment, Care Planning, and Interdisciplinary Care Team:</b></div><div><ul><li>
Ensures identification, assessment, and appropriate person-centered care planning for members.</li><li>
Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home)</li><li>
Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs.</li><li>
Administers the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings based on member&rsquo;s needs. The Care Manager - LP uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports.<ul><li>
The assessment process includes reviewing and transcribing member&rsquo;s current medication and entering information into Vaya&rsquo;s Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care.</li></ul></li><li>
Supports the care team in development of a person-centered care plan (&ldquo;Care Plan&rdquo;) 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.<ul><li>
Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals</li><li>
Ensure the Care Plan includes all elements required by NCDHHS</li><li>
Use information collected in the assessment process to learn about member's needs and assist in care planning</li><li>
Ensure members of the care team are involved in the assessment as indicated by the member/LRP and uses clinical skills to evaluate and incorporate other available clinical information into the assessment as necessary</li><li>
Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions</li></ul></li><li>
Uses clinical skills and expertise to review clinical assessments conducted by providers to ensure all areas of the member&rsquo;s needs are addressed. Care Manager - LP reviews for clinical accuracy and may provide consultation and technical support to providers as needed based on reviews.</li><li>
Interprets and analyzes clinical assessments to draw clinical conclusions to support care management activities.</li><li>
Engages with provider clinical staff to determine clinical appropriateness and course of action when assessments present a wide array of treatment options and members present with complex needs.</li><li>
Helps members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals</li><li>
Ensures that member/legally responsible person (&ldquo;LRP&rdquo;) is/are informed of available services, referral processes (e.g., requirements for specific service), etc.</li><li>
Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process</li><li>
Works in an integrated care team including, but not limited to, an RN and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP could decide who they want involved</li><li>
Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed</li><li>
Solicits input from the care team and monitor progress</li><li>
Ensures that the assessment, Care Plan, and other relevant information is provided to the care team</li><li>
Reviews assessments conducted by providers and consult with clinical staff as needed to ensure all areas of the member&rsquo;s needs are addressed</li><li>
Provide clinical assessment in situations where the member&rsquo;s lack of clinical home or available network provider creates significant risk to member well-being (e.g., need for time sensitive placement/ discharge from inpatient setting)</li><li>
Updates Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member</li><li>
Supports and assists with education and referral to prevention and population health management programs.</li><li>
Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider&rsquo;s crisis plan<ul><li>
Ensures the crisis plan includes problem definition, physical/cognitive limitations, health risks/concerns, medication alerts, baseline functioning, signs/symptoms of crisis (triggers), de-escalation techniques.</li><li>
Provides crisis intervention, coordination, and care management if needed while with members in the community.</li></ul></li><li>
Supports Transitional Care Management responsibilities for members transitioning between levels of care</li><li>
Coordinates Diversion efforts for members at risk of requiring care in an institutional setting</li><li>
Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care.</li></ul></div><div></div><div><b><br>
Collaboration, Coordination, Documentation:</b></div><div><ul><li>
Utilizes advanced knowledge in their work which requires use of their advanced degree and licensure to be able to participate and initiate independent decisions with matters of significance and drive positive clinical outcomes for Vaya members.</li><li>
Executes independent discretion and engages in business decisions for the Vaya Care Management Department that support initiatives to promote Vaya&rsquo;s integrated, whole-person care model for members.</li><li>
Serves as a collaborative partner in identifying system barriers through work with community stakeholders.</li><li>
Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate.</li><li>
Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya&rsquo;s catchment.</li><li>
Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization.</li><li>
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&rsquo; medical, behavioral health, intellectual /developmental disability, medication, and other needs.</li><li>
Participates in other 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.</li><li>
Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards.</li><li>
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.</li><li>
Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders.</li><li>
Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues.</li><li>
Supports and assists members/families on services and resources by using educational opportunities to present information.</li><li>
Verifies member&rsquo;s continuing eligibility for Medicaid, and proactively responds to a member&rsquo;s planned movement outside Vaya&rsquo;s catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service.</li><li>
Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks.</li><li>
Maintains electronic AHR compliance and quality according to Vaya policy.</li><li>
Ensures 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&rsquo;s contracts with NCDHHS.</li><li>
Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies.</li><li>
Participates in Vaya committees, workgroups, and other efforts that require clinical knowledge, as requested, and identified.</li></ul></div><div></div><div><b><br>
Other duties as assigned.</b></div><div></div><div><b><br>
KNOWLEDGE, SKILLS, &amp; ABILITIES</b></div><ul><li>
Ability to express ideas clearly/concisely and communicate in a highly effective manner</li><li>
Ability to drive and sit for extended periods of time (including in rural areas)</li><li>
Exceptional interpersonal skills and ability to represent Vaya in a professional manner</li><li>
Ability to initiate and build relationships with people in an open, friendly, and accepting manner</li><li>
Strong attention to detail and superior organizational skills</li><li>
Ability to make prompt independent decisions based upon relevant facts.</li><li>
Well-developed capabilities in problem solving, negotiation, arbitration, and conflict resolution, including a high level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance.</li><li>
A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure</li><li>
Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change</li><li>
Thorough 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 research</li><li>
Must be highly skilled at shifting between macro and micro level planning, maintaining both the big picture, and seeing that the details are covered.</li><li>
Ability to use higher-level clinical training and licensure to perform clinical assessments, drive positive outcomes for members, support care management colleagues, and offer clinical assistance to providers.</li><li>
Highly skilled at performing clinical assessments of members and identifying member needs.</li><li>
Extensive understanding 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.</li><li>
Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred.</li><li>
Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following:<ul><li>
BH I/DD Tailored Plan eligibility and services</li><li>
Whole-person health and unmet resource needs (ACEs, trauma-informed care, cultural humility)</li><li>
Community integration (independent living skills; transition and diversion, supportive housing, employment, etc.)</li><li>
Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.)</li><li>
Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination)</li><li>
Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.)</li><li>
Serving members with I/DD or TBI (understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.)</li><li>
Serving children (child-and family-centered teams, Understanding the &ldquo;System of Care&rdquo; approach)</li><li>
Serving pregnant and postpartum women with SUD or with SUD history</li><li>
Serving members with LTSS needs (Coordinating with supported employment resources</li></ul></li><li>
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.</li></ul><div></div><div><b><br>
EDUCATION &amp; EXPERIENCE REQUIREMENTS</b></div><p>
Master&rsquo;s degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area. <b>For incumbents with a Master&rsquo;s Degree in a Human Services Area besides Nursing, one of the following required years of experience:</b></p><div><ul><li><b>
Serving members with BH conditions:</b></li></ul></div><div><ul><li>
Two (2) years of experience working directly with individuals with BH conditions</li></ul></div><div><ul><li><b>
Serving members with LTSS needs</b><ul><li>
Two (2) years of prior Long-tern Services and Supports and/or Home Community Based Services coordination, care delivery monitoring and care management experience.</li><li>
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</li></ul></li></ul></div><div></div><div><b><br>
For incumbents with a Master&rsquo;s Degree in Nursing, four years of full-time accumulated experience in mental health with the population served is required.</b> Experience can be before or after obtaining RN licensure.</div><div></div><ul><li><br>
<i>Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104</i></li></ul><div></div><div><b><br>
Licensure/Certification Required:</b></div><div>
Valid licensure required. Acceptable licenses are Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Clinical Social Worker Associate (LCSWA), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Clinical Mental Health Counselor Associate (LCMHCA), Licensed Clinical Mental Health Counselor Supervisor (LCMHCS), Licensed Psychological Associate (LPA), Health Services Professional Psychological Associate (HSP-PA), Licensed Clinical Addiction Specialist (LCAS), Licensed Clinical Addiction Specialist Associate (LCASA), Licensed Marriage and Family Therapist (LMFT) or Licensed Marriage Family Therapist Associate (LMFTA).</div><div></div><ul><li><br>
Due to the multi-disciplinary nature of the LME/MCO business, care managers must operate within their scope of practice, and must engage and leverage other disciplines outside of their own training and credentials.</li></ul><div></div><p><b><br>
Preferred Work Experience:</b></p><div><ul><li>
Experience working directly with individuals with I/DD or TBI</li></ul></div><div></div><div><b><br>
PHYSICAL REQUIREMENTS</b></div><ul><li>
Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.</li><li>
Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers.</li><li>
Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.</li><li>
Mental concentration is required in all aspects of work.</li><li>
Ability to drive and sit for extended periods of time (including in rural areas)</li></ul><div></div><div><b><br>
RESIDENCY REQUIREMENT:</b> The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.</div><div></div><div><b><br>
SALARY: </b>Depending on qualifications &amp; experience of candidate. This position is exempt and is not eligible for overtime compensation.</div><div></div><div><b><br>
DEADLINE FOR APPLICATION:</b> Open Until Filled</div><div></div><div><b><br>
APPLY:</b> Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.</div><div></div><div><br>
Vaya Health is an equal opportunity employer.</div></div><div></div>

Care Manager - LP (McDowell County, NC)

Holston Medical Group

<div><p>If you are a motivated and reliable person with exceptional customer service skills and the ability to thrive in a fast-paced environment, come join Holston Medical Group. We are looking for friendly, courteous employees to ensure a positive patient experience and welcome a teamwork environment.
</p><p><b>WHAT WE OFFER:</b></p>
<ul>
<li>Company paid Life and Accidental Death and Dismemberment Insurance</li>
<li>Company paid Long Term Disability Insurance</li>
<li>401(k) and Roth Retirement plan with Company Contributions</li>
<li>Medical, Dental, Vision, and additional Life and STD Insurance</li>
<li>Health Savings Account Plan with company contributions</li>
<li>Paid time off</li>
<li>Paid Sick time</li>
<li>Paid Holidays</li>
<li>Employee discounts</li>
<li>And more!</li></ul><br>
<p></p>
<p><b>
General Summary:
</b></p><p>The Clinical Care Coordinator will outreach to any patient with a recent hospital admission/discharge, addressing the patient needs and working with the patient to minimize risk of readmission. They will work with the patient for education of a chronic disease state such as, but not limited to, hypertension, diabetes, COPD, CHF, and renal disease. The Clinical Care Coordinator will also work to address patient needs when the Primary Care provider sends a Care Coordination referral on a patient. They will act as a go between for the patient and primary care provider or specialty provider that is assigned to this patient&rsquo;s care team and will schedule patient appointments as needed. The Clinical Care Coordinator will track the patient engagement/enrollment in Care Coordination on tracking spreadsheet (s).</p>
<p><b>
Main Responsibilities:
</b></p><ul><li> Establish close relationships with patients that will increase compliance with treatment recommendations and patient management plans</li></ul>
<ul><li> Maintain communication with providers and collaborate care with patient</li></ul>
<ul><li> Maintain strict confidentiality in all matters relating to patient PHI (Patient Health Information)</li></ul>
<ul><li> Review data within the patient chart which can be used to attest for a HEDIS measure and outreach to the patient for review/discussion of the specific gaps in care</li></ul>
<ul>
<li>Coordinate and schedule appointment for patients to address specific gaps in care. Review payer scorecard and work with Operations Management Team to improve overall STAR rating for the group</li>
</ul>
<ul><li> Coordinate and schedule appointments for patients to address specific patient need</li></ul>
<ul><li> Ensure appropriate documentation or results are listed within the EHR, complete manual attestations within the payer&rsquo;s system for HEDIS gaps in care reporting</li></ul>
<ul>
<li>Review payor scorecard for patient gaps in care.</li>
</ul>
<ul><li> Work with Manager or Clinical Care Coordinator Team Lead on payer scorecards and ways to potentially increase overall STAR rating for organization</li></ul>
<ul><li> Pull the eligible patient list, perform chart review to determine if a patient may qualify for the Eastman Hypertension or Diabetes Program based on program criteria, and work with the Program Director for potential enrollment in the program.
</li></ul><ul><li> Keep track of the patients enrolled in the program utilizing a patient list</li></ul>
<ul><li> Responsible for generating and sending monthly and biannual invoices to Eastman for the patients who are enrolled in the program.
</li></ul><ul><li> Responsible for scheduling patient follow up visits and helping to educate the patient on the disease states of hypertension and diabetes.
</li></ul><ul><li> Work with resources onsite at Eastman for continuation of patient education/disease management and will make appropriate referrals to Cigna Case Management as needed; and will provide Manager or Clinical Care Coordinator Team Lead a weekly list of patients who are outreached for reporting to Cigna Eastman insurance.</li></ul><br>
<p></p>
<p><b>
Education/Experience/Knowledge:</b></p>
<ul><li> Minimum high school diploma or equivalent required</li></ul>
<ul><li> LPN licensed by the state in which employed or Registered/Certified Medical Assistant</li></ul>
<ul><li> Ability to work independently with strict adherence to protocols in an accountable manner</li></ul>
<ul><li> Empathetic and patience to patient/patient family
</li></ul><ul><li> Excellent communication skills &ndash; both written and oral</li></ul>
<ul><li> Superb time management, organizational, critical thinking, and problem-solving skills</li></ul>
<p><b>
Key Competencies:</b></p>
<ul><li> Compassion</li></ul>
<ul><li> Customer focus</li></ul>
<ul><li> Ethics and values</li></ul>
<ul><li> Interpersonal savvy</li></ul>
<ul><li> Problem solving</li></ul>
<ul><li> Critical thinking skills</li></ul>
<ul><li> Empathy</li></ul>
<ul><li> EHR and scheduling proficiency</li></ul>
<ul><li> Basic knowledge of Microsoft Office
</li></ul><ul><li> Knowledge of HEDIS Gap Measures</li></ul><br>
<p></p>
<p>
&quot;We are an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, age, national origin or disability.&quot;</p></div>

Wellspring Counseling

<div><p>Are you passionate about making a meaningful impact in your community through compassionate and faith-centered clinical care? WellSpring Counseling, Central Ohio Youth for Christ (COYFC), and their subsidiaries are seeking a dedicated <b>Community-Based Case Manager/Clinician</b> to join our mission-driven team.</p>
<h4 class="jobSectionHeader"><b>About Us</b></h4>
<p>We are a faith-based organization committed to providing high-quality, trauma-informed care to clients and their families. Our mission is to transform lives through counseling, community outreach, and spiritual growth.</p>
<h4 class="jobSectionHeader"><b>Your Role</b></h4>
<p>As a Community-Based Case Manager/Clinician, you will provide holistic, community-based services that support clients in their journey toward healing and empowerment. You will work collaboratively with families, support teams, and interdisciplinary staff to deliver clinical and case management services, while advancing the mission of COYFC through faith-based outreach.</p>
<h4 class="jobSectionHeader"><b>Key Responsibilities</b></h4>
<p><b>Clinical &amp; Community-Based Services</b></p>
<ul><li>Deliver high-quality case management (TBS and CPST) and clinical services (individual, family, and group therapy).</li>
<li>Build trauma-informed, strengths-based rapport with clients and their support systems.</li>
<li>Develop and implement individualized treatment plans (ITPs) aligned with diagnostic assessments.</li>
<li>Collaborate with interdisciplinary teams to ensure a seamless continuum of care.</li>
<li>Provide referrals and connect families to faith-based community resources and ministries.</li>
</ul>
<p><b>Compliance &amp; Professional Development</b></p>
<ul><li>Maintain active licensure in good standing with the Ohio Social Work and Counselors Board.</li>
<li>Participate in ongoing professional development, training, and conferences to maintain proficiency and CEUs.</li>
<li>Ensure compliance with federal, state, and local standards, including HIPAA and OhioMHAS regulations.</li>
<li>Accurately document services, outcomes, and client progress while meeting productivity standards.</li>
</ul>
<p><b>Administrative Responsibilities</b></p>
<ul><li>Complete timely documentation aligned with agency and regulatory guidelines.</li>
<li>Attend staff meetings, training sessions, and supervision to stay engaged and informed.</li>
<li>Actively contribute to quality improvement initiatives and maintain quality assurance standards.</li>
</ul>
<p><b>Spiritual Responsibilities</b></p>
<ul><li>Represent and uphold the faith-based mission and values of COYFC both at work and in the community.</li>
<li>Lead or contribute to Christian activities, including prayer, Bible instruction, and ministry initiatives.</li>
<li>Provide guidance to clients and families on COYFC&rsquo;s faith values, if requested.</li>
</ul><h4 class="jobSectionHeader"><b>What You Bring</b></h4>
<ul><li>Licensed Social Worker</li>
<li>Experience providing trauma-informed, community-based care.</li>
<li>A passion for integrating faith into your professional practice.</li>
<li>Strong organizational skills, a commitment to compliance, and the ability to meet productivity goals.</li>
<li>Dedication to personal and professional growth.</li>
</ul><h4 class="jobSectionHeader"><b>Why Join Us?</b></h4>
<ul><li>A supportive, mission-driven team that values faith and professional excellence.</li>
<li>Opportunities for personal and spiritual growth.</li>
<li>Competitive benefits and professional development opportunities.</li>
</ul><h4 class="jobSectionHeader"><b>Ready to Make a Difference?</b></h4>
<p>If you&rsquo;re ready to bring hope, healing, and faith to your community, apply today to join the WellSpring Counseling and COYFC family.</p></div>

Community-Based Case Manager/Clinician

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