Manager - MHSU Care Management
Company: Vaya Health
Posted on: November 26, 2022
LOCATION: Remote - Swain/Graham Counties, NC
GENERAL STATEMENT OF JOB:Mental Health/Substance Use(MHSU) Care
Management (CM)Manager is responsible for providing day to day
coaching to assigned MHSU Care Management staff to ensure
responsibilities are carried out effectively and accurately. MHSU
Care Management Manager is also responsible for knowing and
implementing NC Division of Mental Health, Developmental
Disabilities, and Substance Abuse Services standards and
organizational policies.MHSU Care Management Manager is responsible
for providing oversight of the MHSU Care Management team through
providing proactive intervention and coordination of care to
eligible members identified as Special Health Care Needs, Complex
Care Management or High-Risk High Cost populations to ensure that
these individuals receive appropriate assessment and services. The
MHSU Manager is responsible for determining eligibility for care
management and assigning to and managing staff caseloads. The MHSU
Care Management Manager may work with staff, and members if
necessary, in the communities. MHSU Care Management Manager works
with the assigned Care Manager, member and care team to alleviate
inappropriate levels of care or care gaps, coordinate
multidisciplinary team care planning, linkage and/or coordination
of services across the MH/SU/I/DD and other healthcare network(s).
MHSU Care Management Manager works with the assigned Care Manager
who may also provide administrative transition planning assistance
to local hospitals and other institutions. This is a mobile
position with work done in a variety of locations [i.e. member's
home community, provider office(s)]. MHSU Care Management Manager
also works with other Vaya staff, members and family members,
providers as well as community stakeholders. Essential job
functions include, but may not be limited to:
- CM Platform basics
- Outreach & Engagement
- Release of Information practices
- Health Risk Assessment
- Medication List and Continuity of Care process
- Care Planning
- Interdisciplinary Care Team and Ongoing Care Management
- Must reside in North Carolina
Note: 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 Vaya Health. The individual filling this position shall also
sign a confidentiality statement as an employee of Vaya Health.
ESSENTIAL JOB FUNCTIONS:Management:
- Effectively implement organizational priorities, quality
initiatives and programs through the MHSU CM Team.
- Provide administrative direction and clinical guidance to their
team(s) regarding member care and community collaboration
- Proficient in team workflows and use of technology used by MHSU
CMs to complete routine work.
- Represent Vaya Health, as well as their department/Division, at
designated community stakeholder, provider or Department of Health
and Human Service related meetings.
- Provide supervision to MHSU Care Manager team by observing and
monitoring paperwork/documentation to ensure that the following
Care Management activities are carried out within the Vaya
catchment area in an effective manner. Activities include but are
not limited to; employee coaching to ensure continuous improvement
of performance in meeting the needs of the members and communities.
Coaching includes both in person observation as well as
- Conduct performance reviews as required and conduct employee
trainings and job simulation exercises to include but not limited
to policies and procedures and service definitions.
- Work with employee to mediate dissatisfaction within the
- Ensure that MHSU Care Managers have knowledge of duties
described below and carry out these duties within their respective
teams by providing direct supervision.
- May provide direct CM activities in situations that require
such as staff shortages or an elevated need for services.
- Ensures identification, assessment and appropriate
Person-Centered Care Planning for members identified as having
Special Health Care Needs or as High-Risk High Cost members (as
supported by state funds) or other complex care management
populations in order to link to determine appropriate formal and
informal services and supports including a medical and behavioral
health home and monitor services.
Clinical Assessment, Care Planning & Interdisciplinary Care Team:
- MHSU CM Managers will ensure that MHSU Care Managers have
knowledge of duties described below and carry out these duties by
providing direct supervision, case review and reviewing operational
- MHSU CM Managers ensure MHSU CM meet with members to conduct a
comprehensive bio-psycho-social assessment in order to gather
information on their overall health, including behavioral health,
developmental, medical and social needs. The Health Risk Assessment
(HRA) encompasses a comprehensive assessment addressing social
determinants of health, mental health history and needs, physical
health history and needs, intellectual/developmental disabilities,
activities of daily living, access to resources, and other areas to
ensure a whole person approach to care.
- MHSU Care Manager may administer the PHQ-9, GAD, CRAFT, ACES,
LOCUS/ CALOCUS, and other assessments based on member's clinical
needs. Scores are calculated and reviewed allowing MHSU CM to
provide specific education and self- management strategies as well
as linkage to appropriate therapeutic support(s). The assessment
process includes reviewing and transcribing member's current
medication and entering information into Vaya's Care Management
platform to trigger the continuity of care process which results in
the creation of a multisource medication list that is shared back
with prescribers to promote integrated care.
- MHSU CM Manager ensures MHSU CM uses the assessment to learn
about the member's needs to assist the member and their team in
planning for their care, prioritizing goals that to help them live
the life they want in the community of their choice. MHSU Care
Managers ensure members of the care team are involved in the
assessment as indicated by the member and that other available
clinical information is reviewed and incorporated into the
assessment as necessary. Care Plans and CM assessment are updated
at a minimum of annually or when there is a significant life change
for the member.
- MHSU CM Managers ensure MHSU CM use the assessment to create a
person-centered care plan for members to help define what is
important to members for their health. Care Plans are created based
on information collected in the assessment process. MHSU CM assist
members in refining and formulating treatment goals, identifying
interventions, measurements and barriers to the goals.
- MHSU CM Managers ensures MHSU CM 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.
MHSU CM and member solicit input from the care team and monitor
- MHSU CM Managers ensure Care Plans completed by MHSU CM include
specific services to address mental health, substance use or
intellectual/developmental disability, medical and social needs as
well as personal goals.
- MHSU CM Managers ensure MHSU CM allows members/guardians to
have the opportunity to decide who they want at the care team
meeting, coordinates, and may facilitate the team meeting where
member Care Plan is discussed and reviewed.
- MHSU CM Managers ensure MHSU CM provide the assessment, care
plan and other relevant information to the care team as indicated
in Vaya policy and necessary Care Plan elements are included in
accordance with 2335.
- MHSU CM Managers ensure MHSU CM complete Crisis planning with
member and care team. MHSU Care Managers create a care management
crisis plan which is a separate but complimentary to the behavioral
health provider's crisis plan. MHSU CM collaborates with members to
develop a Crisis Plan that is tailored to their needs and desires.
The MHSU Care Manager 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. Provide crisis intervention,
coordination, and care management if needed while with members in
Collaboration:MHSU Care Management Manager will ensure MHSU Care
Managers have knowledge of duties described below and carry out
these duties by providing direct supervision:
- May provide services in situations that require such as staff
shortages or an elevated need for services. Serves as a
collaborative partner in identifying system barriers through work
with community stakeholders.
- Manages and facilitates Child/Adult High-Risk Team meetings in
collaboration with DSS, DJJ, CCNC, school systems, and other
community stakeholders as appropriate.
- Works in partnership with other Vaya departments to address
identified needs within the catchment. MHSU CM may participate in
cross-functional clinical and non-clinical meetings and other
projects to support the department and organization.
- Participate in routine multidisciplinary huddles including RN,
Pharmacist, M.D. to present complex clinical case presentation and
needs, providing support to other CM's and receiving support and
feedback regarding CM interventions for clients' medical,
behavioral health, intellectual /developmental disability,
medication, and other needs.
- MHSU CM participates in other high risk multidisciplinary
complex case staffings as needed to include Vaya Medical Director,
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.
QUALIFICATIONS & CREDENTIALING REQUIREMENTS:A Master's Degree in A
field related to health, psychology, sociology, social work,
nursing, or another relevant human services area or licensure as an
RN with three (3) years of experience providing care management,
case management, or care coordination to the population being
- Close visual acuity to perform activities such as preparation
and analysis of documents; viewing a computer terminal; and
- 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,
sitting for extended periods of time.
- Mental concentration is required in all aspects of work.
- Ability to drive and sit for extended periods of time
(including in rural areas)
KNOWLEDGE OF JOB:
- Ability to express ideas clearly/concisely
- Represent Vaya in a professional manner
- An ability to initiate and build relationships with people in
an open, friendly, and accepting manner
- Ability to take ownership of projects from planning through
- Strong attention to detail and superior organizational
- Ability to multitask and prioritize to manage multiple projects
on tight timelines
- Ability to understand the strategic direction and goals of the
department and support appropriate processes to facilitate
achievement of business objectives
- Well-developed capabilities in problem solving, negotiation,
conflict resolution, and crafting efficient processes
- A result and success-oriented mentality, conveying a sense of
urgency and driving issues to closure
- Comfort with adapting and adjusting to multiple demands,
shifting priorities, ambiguity, and rapid change
- Proficiency in Microsoft Office and Vaya systems, to include
Excel, data analysis, and secondary research
- Demonstrated knowledge of the assessment and treatment of
developmental disabilities, without co-occurring mental
- Have highly effective communication
- Knowledge in Vaya Medicaid B and C Waivers, NC Innovations
Waiver, and accreditations and apply this knowledge in
problem-solving and responding to questions/inquiries
- Have a dynamic, proactive approach to assessment, screening,
monitoring and coordination of care, to ensure quality supports and
consistent adherence to waiver requirements
- This is a mobile position with work done in a variety of
locations spending a considerable amount of time in the field
- Employee will participate in and maintain Care Management and
Vaya trainings and proficiencies as required.
- 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. Must be highly skilled at shifting
between macro and micro level planning, maintaining both the big
picture and seeing that the details are covered.
- MHSU CM Managers must exhibit an extensive understanding of the
Diagnostic and Statistical Manual of Mental Disorders (current
version) and have considerable knowledge of the MH/SU/DD service
array provided through the network of Vaya providers. Additional
knowledge in Vaya Medicaid B and C waivers and accreditation is
- The employee must be detail oriented, able to organize multiple
tasks and priorities, and to effectively manage projects from start
to finish. 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
- Training, learning and proficiency are tracked through the Care
Management Training Matrix and any other required means. Training
may be delivered in a variety of methods and forums. MHSU CM
Manager must understand the following areas, in addition to other
BH I/DD Tailored Plan eligibility and services
- Whole-person health and unmet resource needs (ACEs, Trauma,
- Community integration (Independent living skills; transition
and diversion, supportive housing, employment, etc)
- Components of Health Home Care Management (Health Home
overview, working in a multidisciplinary care team, etc)
- Health promotion (Common physical comorbidities,
self-management, use of IT, care planning, ongoing
- Other care management skills (Transitional care management,
motivational interviewing, Person-centered needs assessment and
care planning, etc)
- Serving members with I/DD or TBI (Understanding various I/DD
and TBI diagnoses, HCBS, Accessing assistive technologies,
- Serving children (Child- and family-centered teams,
Understanding of the "System of Care" approach)
- Serving pregnant and postpartum women with SUD or with SUD
- Serving members with LTSS needs (Coordinating with supported
- MHSU CM Managers should be proficient in the aforementioned
essential job functions. 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.
- In addition, MHSU CM Managers must have thorough knowledge of
standard office practices, procedures, equipment and techniques and
have intermediate to advanced proficiency in Microsoft office
products (Word, Excel, Power Point, Outlook, Teams, etc)LICENSURE:A
license, provisional license, certificate, registration or permit
issued by the governing board regulating a human service profession
(examples include LCSW, LMFT, LCAS, LCMHC, LPA, RN).
- If RN, licensure as an North Carolina RN (see education
LOCATION REQUIREMENT:In accordance with the BH and I/DD Tailored
Plan requirements mandated by the NC Department of Health and Human
Services, certain Vaya Health positions are required to be filled
by individuals who reside in North Carolina, meaning someone who
establishes a legal domicile in North Carolina and pays income tax
in North Carolina, or resides within 40 miles of the North Carolina
border. New hires from outside of North Carolina will have 60 days
from the date of hire to meet this requirement, if applicable to
the position.This position is required to reside in North Carolina
or within 40 miles of the North Carolina Boarder.
SALARY: Depending on qualifications & experience of candidate. This
position is exempt and is not eligible for overtime
DEADLINE FOR APPLICATION: Open until filled
APPLY: Vaya Health accepts online applications in our Career
Center, please visit http://www.vayahealth.com/careers-overview/
Vaya Health is an equal opportunity employer.
Keywords: Vaya Health, Knoxville , Manager - MHSU Care Management, Executive , Robbinsville, Tennessee
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