Position:LTSS - Clinical Care Manager

Department: BAP Program

Schedule: Full Time

POSITION SUMMARY:

The LTSS Clinical Care Manager (CCM) works collaboratively with the LTSS care team to provide person-center delivery LTSS CP supports to Enrollees. The CCM arranges, coordinates, monitors, evaluates, and advocates for services to meet the psychosocial needs of the Enrollee. The CCM works with the Enrollee to increase their capacity for self-management and to promote behavioral changes that facilitates short- and long-term linkages with necessary community, social service, medical or behavioral health resources. The population includes both adult and pediatric Enrollees many of whom, may require LTSS, are developmentally delayed, or are identified as having special needs.

ESSENTIAL RESPONSIBILITIES / DUTIES:

Key Functions/Responsibilities:

• Provides clinical oversight and supervision for assigned LTSS Care Coordinators, in collaboration with site Project Managers, as applicable

• Utilizes motivational interviewing techniques, systems theory, change theory, acceptance, and commitment approaches, patient activation, and psycho-education to engage Enrollees in care management

• Supports and enhances the Enrollee's capacity to self-manage by detecting underlying mental/behavioral health issues impacting general health

• Establishes and maintains effective working relationships and provides outreach and education to key service agencies, providers and other Enrollees of the interdisciplinary team

• Maintains flexibility and adjusts approach to the needs of the Enrollee and the team.

• Meets with Enrollees, family, and other supports, during office visits, at Enrollee's home, or, in the community

• Assists the Enrollee, when necessary, in placing calls, completing applications, and advocating for available supports/services

• Maintains general knowledge of the most common conditions presented in the Medicaid population and is able to assess, manage and triage at-risk, high-needs Enrollees.

• Researches and shares community resources with Enrollees and peers.

• Contributes to the development of a comprehensive care plan (CP) for the Enrollee

• Collaborates with LTSS Care Coordinator to provide in-home/face-to-face visits to enhance Enrollee engagement and communication

• Reviews, provides feedback on, suggests amendments to, and gives final approval of Enrollee Health-Related Social Needs (HRSN) screens and Care Plans completed by the LTSS Care Coordinator

• Develops and maintains community relationships providing outreach to community and state agencies and school systems

• Facilitates interdisciplinary consultation on Enrollees' behalf through participation in rounds, team meetings, and clinical reviews.

• Conducts face-to-face visits with selected Enrollees as appropriate.

• Completes documentation in the medical management information system in a timely manner and in keeping with, internal policy and HIPAA standards.

• Other duties as assigned.

Reports to: Senior Operations Manager

Supervision Exercised:

• LTSS Care Coordinators

Supervision Received:

• Weekly and ongoing

JOB REQUIREMENTS

EDUCATION:

• Bachelor's degree in Nursing / Associate's Degree in Nursing and relevant work experience OR

• Master's Degree in a relevant field

EXPERIENCE:

• 2 years of experience working with individuals with complex medical/behavioral and/or psychosocial needs. Behavioral Health and/or Pediatric experience strongly preferred

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Pre-employment background check

• Current unrestricted, applicable, state license to practice as a Registered Nurse or LCSW or Licensed Occupational Therapist or other applicable licenses

• CCM certification preferred

• Regular and reliable transportation and the ability to conduct face-to-face appointments with members, providers, community and state agencies

KNOWLEDGE AND SKILLS:

• Strong oral and written communication skills

• Ability to establish and maintain effective working relationships with Enrollees, social service agencies, community resources, and other members of the interdisciplinary team.

• Ability to work with Enrollees to promote positive behavioral change

• Strong Motivational Interviewing skills

• Bilingual desired

• Strong organizational and time management skills

• Ability to work in a fast-paced environment and multi-task

• Proficient Microsoft Office skills particularly MS Outlook and MS Word and other data entry processing applications

• Knowledge of medical terminology

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.

• Work is generally performed in the field with some home/corporate office work. Position is eligible for telework.

• No or very limited physical effort required.

• No or very limited exposure to physical risk.

Equal Opportunity Employer/Disabled/Veterans