Primary Purpose of Position: This position fulfills the Tailored Plan requirement for the State Funding BH Care Management Coordinator. This position will develop policies, practices, and systems that support the provision of case management services. Additionally, this position will act as a care management coordinator for members receiving the Assertive Community Treatment (ACT) team service. Since members receiving this service are not eligible for Tailored Care Management (ACT), this position will assist ACT providers with meeting the care management expectations outlined in the ACT clinical coverage policy. This position is expected to build and sustain strong working relationships with cross functional departments and assigned ACT providers. The ACT Clinical Support Specialist ensures timely submission of routine and ad hoc reporting by assigned ACT providers and reviews performance dashboard data regarding clinical outcomes. This position has a critical role in the clinical performance monitoring of ACT providers.
Additionally, this individual shall serve as the point of contact for TRICARE, the North Carolina National Guard's Integrated BH System, the Army Reserve Department of Psychological Health, the United States Department of Veterans Affairs, the Juvenile Justice Section of the Division of Adult Correction and Juvenile Justice, and related organizations to ensure that members of the active and reserve components of the Armed Forces of the United States, veterans, and their family members have access to State-funded services when they are not eligible for federally funded mental health or substance abuse services.
Role and Responsibilities:
State-funded Care Management Coordination:
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Assessing the case management provider network and working with the network management staff to identify gaps in the case management provider network based upon the Network Access Plan
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Monitoring the delivery of case management services
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Ensuring potential referral sources are aware of case management providers in their areas
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Providing support to case management providers
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Assisting case management providers with identifying and coordinating appropriate placement for recipients with complex needs
Orientation/Ongoing Training and Technical Assistance for ACT Providers
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Conducting ongoing education to assigned ACT providers and their staff regarding the requirements of the clinical coverage policy.
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Educating assigned ACT providers on requirements related to special populations (e.g. Transitions to Community Living, Long-Term Services and Supports, etc.)
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Assisting with identifying & developing ACT provider training to meet ACT provider needs.
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Conducting ACT provider meetings to share and discuss issues of concern, troubleshoots for issue resolution, and implements an escalation process for discrepancies.
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Handling or ensuring appropriate scheduling, agenda, materials, location, of ACT provider meetings as needed.
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Serving as a resource to other departments within the organization on ACT provider-related issues.
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Participating in Provider Forums as requested and providing technical support and assistance to Provider Council as needed
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Participating in internal workgroups that involve ACT providers.
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Collaborating with all levels of the organization including Executive Leadership Team, Departmental Directors, and Managers to assist with problem resolution.
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Actively participating with subgroups/initiatives to further network development and adequacy for Tailored Care Management.
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Enhancing relationships with ACT providers by investigating, documenting, and resolving ACT provider matters.
Performance Monitoring/Reporting
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Participating in monthly ACT Quality Monitoring workgroup
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Collaborating with other departments, including IT, to ensure provider data is collected to support performance monitoring and reporting.
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Overseeing identified performance measures with assigned ACT providers.
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Collaborating with Operations Manager to identify business requirements, needed reports to monitor and track performance.
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Assisting in development of ACT dashboards.
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Providing information and status updates for ACT providers regarding performance and how to maximize their performance.
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Assisting with required internal and external data tracking and performance reporting.
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Regularly meeting with other internal departments to create, revise and adjust strategy for ACT providers.
Other
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Participating in internal and external committees, as assigned.
Knowledge, Skills and Abilities:
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Considerable knowledge of the policies and contractual requirements related to ACT
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Strong data management/analysis skills
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Exceptional interpersonal and communication skills
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Strong problem solving, negotiation, arbitration, and conflict resolution skills
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Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint)
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Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies
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Ability to make prompt independent decisions based upon relevant facts
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Ability to establish rapport and maintain effective and collaborative working relationships
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Ability to act with tact and diplomacy in all situations
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Ability to maintain strict confidentiality in all areas of work
Education/Experience Required:
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Master’s level fully Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Psychological Associate (LPA), Licensed Marriage & Family Therapist (LMFT), or Registered Nurse (RN).
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Three years of supervisory experience of staff working directly with individuals with a behavioral health condition who have complex needs.
Other requirements:
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Must reside in North Carolina.
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Must have ability to travel regularly as needed to perform the job dutie
Education/Experience Preferred: Consultation and quality management experience preferred. Care Management experience preferred.
Licensure/Certification Requirements: A Master’s level fully Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), or a Licensed Psychological Associate (LPA)