Transitional Care Manager Jobs in Raleigh, NC (NOW HIRING)

• Submit required documentation to the payor to ensure timely delivery of services and trouble shoots until authorization is obtained. Notifies care team as appropriate of successful authorization.
• Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information.
• Completes activities related to Plans of Care
• For facility (ICF, Hospital, PRTF or SOC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.
• Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan.
• Schedule and facilitate the Care Plan meeting.
• Coordinate with other team members to ensure smooth transition to appropriate level of care.
• Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.
• Update other Care Team members of urgent or pertinent treatment updates.
• Recognize and report critical incidents to supervisors.
• Schedule face to face meeting with member/LRP to provide education about care teams, services, needed supports, etc.
• Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance.
• Ensure that medication monitoring and reconciliation occur.
• Escalate complex cases and cases of concern to Supervisor.
• Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.
• Verify ongoing service adherence with member and/or guardian.
• Document all applicable member updates and activities per organizational procedure.
• Ensure that service orders/doctor's orders are obtained, as applicable.
• Obtain releases/documentation and provide to all stakeholders involved.
• Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information.
• Ensure clinical documentation (e.g., goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements.
• Participate and complete all required agency trainings and meetings, as well as all required care management-based trainings from the State, Technical Assistance entity or payor and within required timeframes as assigned.
• Travel to various community locations, other agencies, and other outreach destinations as necessary to meet the members' needs.
• Maintain all certification(s) or licensure required for the position.
• Demonstrate awareness and knowledge of and comply with all agency policies and procedures, as well as state and federal statutes and regulations related to care management.
• Meet at least minimum standards of monthly contacts and demonstrate ability to effectively engage with members.
• Care manager will coordinate the member's health care and social services including behavioral health and pharmacy services as well as other SDOH needs.
• Participate in agency's twenty-four (24) hour coverage around care management providing for coverage for services, consultation or referral as needed and arrange treatment for emergency medical conditions including behavioral health crises. Specifically, coverage will include the ability to share information such as care plans and psychiatric advance directives and coordinate care to place the member in appropriate setting during urgent and emergent events.
• Complete all other relevant responsibilities as assigned by supervisor.

Qualification/Education/Experience:

• A Bachelor's degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area, or licensure as a registered nurse (RN) and Two years of experience working directly with individuals with behavioral health conditions
• Outpatient and or multi-specialty group/practice experience
• Experience working with Medicaid funded programs.

• Great communication and interpersonal skills when dealing with clinical staff and patients.
• Detailed knowledge of policies and regulations in the clinical field