This is a new supervisor of care manager positions specializing in providing care management and coordination to individuals with and intellectual and other developmental disabilities (IDD).   This position can also serve as an IDD expert as CIHA continues to build out the specialty areas of IDD or TBI (Intellectual & Developmental Disabilities) /TBI (Traumatic Brain Injury).

Primary Purpose of the Position

The IDD/TBI (Intellectual & Developmental Disabilities) /TBI (Traumatic Brain Injury)

Care Manager Supervisor is responsible for the design, implementation, and ongoing operations of services and supports for care managers serving IDD or TBI.  The position is responsible for supervising care managers who work with individuals with complex chronic IDD and/or TBI diagnoses and their navigation with the medical, pharmacy, behavioral health system and other support systems in the least restrictive environment to meet the needs, desires and wants of the individual. The Supervisor shall provide oversight and guidance to the care managers in providing a person-centered approach to identify, service and support needs and link to the most effective service and supports at the appropriate level of care and provide assistance in managing chronic illness and other conditions, provide education about the Person-Centered and “system of care” approaches in collaboration with stakeholders, monitoring person-centered planning effectiveness, quality of care and ensure the use of evidence-based best practice service delivery methods.

Job Summary:

Essential Duties and Responsibilities:

50% Supervision and Management:

• Assure that Care management for Tribal Option, SP, TP, CFSP and other Medicaid/Health Choice individuals with IDD or TBI receive industry IDD/TBI standards care management, services and supports that are evidence based, evidence informed or generally acceptable practice.
• Build and enhance Care Managers knowledge base, expertise, and capability to provide care management to these specialty populations across multiple disciplines, systems, providers and support entities.
• Ensures staff are well trained in and comply with all organizational and department policies, procedures, business processes and workflows.
• Ensures that care managers have the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with applicable licensure, regulatory and accreditation requirements as applicable and renewal credits.
• Review all Individual Support Plans (ISPs) or Person-Centered Plans and will provide guidance to care managers on how to meet members’ needs.
• Participate in and provide leadership in case staffing for individuals with IDD/TBI

   

• Responsible for planning, directing, and organizing the work of supporting care mangers and oversight of services and supports rendered; establish effective professional goals and work plan objectives.
• Maintain staffing supporting IDD/TBI to meet the needs of the program including personnel administration to include but not limited to recruiting, selecting and managing employees; delegating to staff; encouraging and fostering professional development.
• Assures person centered planning methods/strategies are utilized to gather information for individuals supported. Each member will receive integrated, whole- person care management from a single care manager with expertise and training in addressing behavioral health, I/DD, and/or TBI needs in addition to physical health needs, unmet health-related resource needs and other entities such as school, vocational and other entities providing supports to the individual.
• Assures that care managers consistently complete Discovery activities (information gathering and assessment) in advance of planning meetings and prepares the members for active participation in their care plan meeting.
• Assures comprehensive assessments address all required information and are timely completed to identify needs for treatment or monitoring.
• Assures timely development of the Person-Centered Plan/Individual Service Plan (ISP), crisis plan and Behavior Support Plan (as applicable).
• Assures that assessments/plans are updated, as needed, whenever the individual’s life circumstances change, and documentation is complete and timely in the care management platform.
• Assures that the required components of the care managers and the members enrolled in medical homes are in place.These include but not limited to:
  • Care Coordination
  • Annual physical exam
  • Continuous monitoring
  • Medication Monitoring
  • Adherence to System of Care components and CIHA Nuka model of care management
  • Individual and Family Supports
  • Health Promotion
  • Addressing unmet health-related resource needs such as securing, referring and coordinating with disability benefits, food and income supports, housing, transportation, employment options, financial literacy, child welfare, rehabilitative services, domestic violence, legal service, service for justice involved individuals, applications,
  • Overseeing transition and transitional care management for IDD and TBI cases
  • Ensuring the activities of diversion and in-reach occur as applicable
  • Ensuring that care coordination/management occurs for individuals with co-occurring disorders of IDD and other conditions.
  • Provide subject matter expertise of ensuring that health IT which includes use of EHR, care management data system and platform, data sources for risk stratification such as ADTs, claims, etc. reflects the uniqueness of IDD/TBI.
  • Utilizes NCCare360 or Tribal equivalent
  • Provide guidance and expertise for risk stratification in the area of IDD/TBI
  • Provide active and meaningful training and education in the area of IDD/TBI
  • Other activities and tasks required to meet the needs of the population

   

  20% Training and Collaboration

• Review, modify, implement, and maintain a comprehensive training program for care managers of IDD or TBI.Provides education and support to care managers of IDDTBI in the following requirements established by NC DHHS and by CIHA.Topics include but not limited to:
  • Learning about and exercising individual rights, self-advocacy, personal direction, resiliency, and independence.Identifies strategies and tools to prepare individuals/legally responsible persons having information of services available, service options and processes (e.g., requirements for specific service), etc.
  • Provide information to individuals/legally responsible persons regarding their choice in choosing service providers, ensuring objectivity in the process.
  • Whole-person health and unmet resource needs
  • Community integration
  • Components of Health Home care management
  • Health promotion
  • Other Care Management Skills, including specialty for care managers and supervisors serving IDD/TBI, Children, pregnant and postpartum with SUD or SUD history, and LTSS needs.
  • Adoption of evidence-based evidence informed practices for the individuals being served.
  • Understanding various I/DD and TBI diagnoses and their impact on the individual’s functional abilities, physical health, and behavioral health (i.e., co-occurring mental health diagnosis), as well as their impact on the individual’s family and caregivers.
  • Understanding HCBS, related planning, and 1915(c) services and requirements; Accessing and using assistive technologies to support individuals with an I/DD or a TBI.
  • Understanding the changing needs of individuals with and I/DD or a TBI as they age, including when individuals age out of school-related services; transitional ages of work and retirement
  • Educating Members with an I/DD or a TBI about consenting to physical contact and sex.
  • Methods for coordinating with supported employment resources available through the NC DHHS, the Division for Vocational Rehabilitation, Tribal VOC, and other general employment resources such as the Employment Security Commission.
• Provide consultation to the AMH, Tribal Option, AMH+/CMA and the CIHA care management teams.

20% Documentation and Accountability

• Provide continual evaluation of processes and procedures and recommend methods to improve operations, efficiency, and service.
• Build, enhance, and monitor key performance metrics, reports, and dashboard to address improvement and adopted PIPs and population health program and initiatives.
• Proactively monitor documentation of care mangers to ensure that issues/errors are resolved as quickly as possible.
• Conduct onsite visits with providers of IDD services rendering services and supports to individuals and make recommendations accordingly to address the care management needs.
• Recommend and lead the implementation of care management practices and other tools; identify needs to increase care management effectiveness and efficiency.
• Ensures all clinical documentation (e.g., goals, plans, progress notes, etc.) meet state, CIHA and Medicaid requirements.
• Conducts record audits and provides guidance to care managers to maintain compliance/quality, as demonstrated by >95% compliance on Qualitative Record Reviews/Chart Audits.

10% Other duties as assigned including participation in IDD/TBI specific work groups, task forces, listening sessions and offering expertise through the IDD lens.  This also includes working with the TPs on referrals and access to the Innovations Waiver.

Education/Experience/Minimum Qualifications

• A bachelor’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services areas such as special education AND Five years of experience providing care management, case management, or care coordination to complex individuals with I/DD or TBI;

  OR

• A master’s degree in a field related to health, psychology, sociology, social work (e.g., LCSW), nursing, or another relevant human services area such as special education, or licensure as an RN and Three years of experience providing care management, case management, or care coordination to individuals with an I/DD or a TBI.

Job Knowledge

• IDD/TBI Care Manager Supervisor must exhibit an extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and have considerable knowledge of the MH/SUD/DD service array provided through the network of providers, internal and external to the EBCI health system. Additional knowledge in Medicaid 1115, B and C waivers and other accreditation bodies is essential.
• The supervisor must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish.He/She must be able to independently organize multiple tasks and priorities and to effectively manage and assigned caseload under pressure of deadlines. Work activities quickly change according to mandated changes and changing priorities within the department.The employee must be able to change the focus of his/her activities to meet changing priorities.Proficiency in Microsoft Office products (such as Word, Excel, Outlook, PowerPoint, etc.) is required.

• A demonstrated knowledge of the assessment, person-centered planning and thinking, treatment and support of IDD/TBI, with or without co-occurring behavioral health and other chronic conditions, is a necessity.
• This position requires exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes.Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers.
• Ability to establish and maintain effective working relationships with members of the CIHA team, individuals and their families, and a variety of governmental and private resources and organizations in the community.
• Ability to express ideas clearly and concisely and to plan and execute work effectively.
• Must be able to read, research, and interpret computer data or customer service platform information related to patient/member interviews and eligibility searches. Basic knowledge of eligibility requirements of the Cherokee Indian Hospital and Medicaid managed care plans including resources in the local community and neighboring counties.
• Requires knowledge of various software packages: i.e. Microsoft Excel, Word, Outlook, and the ability to utilize Care Management Platform/EHR and ability to enter information or data into the applicable software package.
• Knowledge of interview techniques and experience in applying various policies and procedures in the performance of assigned duties. Must be able to maintain specified records, files, and logs of the department.
• Requires the ability to work independently or as a member of a team.
• Valid NCDL required.
• Knowledge and ability to work within multiple systems simultaneously.
• Knowledge of the population served and about the Cherokee culture preferred.

Complexity of Duties

Care Manager Supervisor will work across a broad range of health, behavioral health, and other support agencies often with specific requirements and timelines.  Navigating the various systems can be complex.  The individual being served may also have conditions or challenges that are complex and when co-occurring conditions manifest can complicate the care management and navigation required.  Seeking consultation when required and generalizing concepts will be critical. Must be highly skilled at shifting between macro and micro level planning, maintaining both the big picture, and seeing that the details are covered. 

Supervision Received

Position requires the ability act independently and to use judgement when to make decisions and when to seek supervision or escalate a situation to the Director of Care Management or other CIHA management team memebers.  The Care Manager Supervisor will conduct individual staff supervision sessions, conduct staff meetings, or team meetings and will seek consultation from the team members or external consultants to meet the needs the individuals served.  Individual supervision will occur on a regular basis. 

Responsibility for Accuracy

Position is expected to make appropriate decisions that will result in care managers being successful in serving their members in the caseload and maintaining compliance to requirements and CIHA Nuka model of care management.  Timely and accurate review of reports, dashboards and other documents required for operations is necessary. 

Contact with Others 

The Employee will have the ability to learn and understand medical, legal, waiver and program practices/requirements.  This knowledge will be applied in problem-solving and in response to questions/inquiries.  Interpersonal skills and effective communication are of utmost importance.  This position requires the staff to modify communications styles to meet the preferences and level of understanding of providers, individuals, families, and other interested parties.  This could be a significant range of communication techniques including the use of augmentative/assistive communication devices and translators/interpreters. 

A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.  This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts.  Problem solving, negotiation, arbitration and conflict resolution skills are essential to balance the needs of both internal and external customers.

Confidential Data

All health information and data is considered highly confidential and strict adherence to all applicable policies is required. The position has access to highly confidential patient/member medical and personal information.  The Privacy Act of 1974 mandates that the incumbent shall maintain complete confidentiality of all administrative, medical, and all other pertinent information that comes to his/her attention or knowledge.  The Act carries both civil and criminal penalties for unlawful disclosure of records. This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws.

As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of CIHA. The individual filling this position shall also sign a confidentiality statement as an employee of CIHA.  Violations of such confidentiality shall be cause for adverse action. The individual must always adhere to all CIHA/EBCI confidentiality and security policies and procedures.

Mental/Visual/Physical

The level of concentration varies with tasks, with close attention to detail required while entering data and verifying accuracy of information. Duties of this position require the employee to be mobile, reach with hands and arms, speak, and hear. Must have visual acuity. Position is subject to frequent interruptions, requiring varied responses. Must be able to handle multiple projects simultaneously, work independently, and meet deadlines and time frames. Person in this position is required to have close visual acuity to perform activities that include viewing a computer screen and extensive reading.  Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, unless assisting an individual in their setting, and sitting for extended periods of time.

The position is required to travel as necessary to meetings, make home visits and assist with interventions as necessary. 

Resourcefulness and Initiative

Follows well defined procedures with initiative and judgment required maintaining accuracy and complete tasks in a timely fashion.   

Environment

Work is performed within the hospital environment, the individual’s home and in community settings in which the individual lives, learns, works, or plays.   Frequent out of office travel is required.  Minimal overnight travel is required and would be most likely be associated with attendance at training events or conferences at the employee’s discretion.  Immunizations are required of all employees.

Customer Service

Consistently demonstrates superior customer service skills to patients/customers/members by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all patients/customers/members by seeking out opportunities to be of service.