Care Manager – LP

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Deliver proactive intervention and care coordination for eligible Vaya Health members.

• Evaluate members’ behavioral, developmental, medical, social, pharmacy, LTSS, and unmet health-related resource needs.

• Recognize and mitigate inappropriate levels of care and care gaps through assessment, multidisciplinary care planning, and service coordination.

• Connect members with suitable formal and informal services and supports across various health domains.

• Conduct thorough Health Risk Assessments that address social determinants of health and holistic needs.

• Administer PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other needs-based screenings.

• Review and document medications, maintaining comprehensive medication lists in Vaya’s care management platform.

• Assist in the development, management, and annual or life-change updates of person-centered care plans.

• Ensure that care plans meet mental health, substance use, medical, social, and personal goals, along with NCDHHS requirements.

• Examine provider clinical assessments for precision, offer consultation and technical support, and interpret findings for care management.

• Engage with provider clinical staff regarding treatment options and complex member needs.

• Organize care team meetings and collaborate with members, legally responsible persons, providers, RNs, pharmacists, physicians, families, and community stakeholders.

• Create customized Care Management Crisis Plans and provide crisis intervention, coordination, and care management as necessary.

• Support Transitional Care Management and coordinate diversion efforts for members at risk of institutional placement.

• Lead and facilitate Child/Adult High-Risk Team meetings with DSS, DJJ, CCNC, school systems, and community stakeholders.

• Identify and address gaps in services and access to care within Vaya’s catchment area.

• Monitor service delivery, quality of care, compliance, critical incidents, and member health and safety.

• Confirm ongoing Medicaid eligibility and respond to members’ relocation outside Vaya’s catchment area.

• Generate and supervise complete, accurate, and timely documentation in the administrative health record.

• Uphold compliance with HIPAA, Vaya policies, federal and state regulations, and NCDHHS contracts.

• Participate in training, multidisciplinary huddles, committees, workgroups, meetings, and other departmental projects.

• Perform additional duties as assigned.

⛳️ Requirements

• Master’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area.

• Must fulfill the criteria to be a North Carolina Qualified Professional with the population served under 10A NCAC 27G .0104.

• Valid licensure required: RN, LCSW, LCSWA, LCMHC, LCMHCA, LCMHCS, LPA, HSP-PA, LCAS, LCASA, LMFT, or LMFTA.

• For a Master’s Degree in a Human Services Area other than Nursing: two years of experience working directly with individuals with BH conditions.

• For Human Services master’s degree holders serving members with LTSS needs: two years of prior Long-Term Services and Supports and/or Home Community Based Services coordination, care delivery monitoring, and care management experience; this may coincide with required behavioral-health experience or experience with individuals with I/DD or TBI.

• For a Master’s Degree in Nursing: four years of full-time accumulated experience in mental health with the population served; experience may be before or after RN licensure.

• Strong ability to articulate ideas clearly and communicate effectively.

• Capability to drive and sit for extended periods, including in rural areas.

• Outstanding interpersonal skills and professional representation of Vaya.

• High attention to detail and excellent organizational skills.

• Competence to make prompt independent decisions based on relevant information.

• Skills in problem solving, negotiation, arbitration, and conflict resolution.

• Intermediate to advanced proficiency in Microsoft Office products and Vaya systems.

• Ability to perform clinical assessments and identify member needs.

• Comprehensive understanding of the current Diagnostic and Statistical Manual of Mental Disorders within scope.

• Significant knowledge of the MH/SU/IDD/TBI service array provided through Vaya’s provider network.

• Ability to complete and maintain all required Vaya trainings and proficiencies.

• Experience working directly with individuals with I/DD or TBI is preferred.

• Must reside in North Carolina or within 40 miles of the North Carolina border.

🏝️ Benefits

• Exempt position; not eligible for overtime compensation.

• Mobile position with work conducted in various locations, including members’ home communities.

• Open until filled.