RN Tailored Care Manager
Remote - North Carolina, United States
JOB SUMMARY:
The RN Tailored Care Manager provides comprehensive, person-centered services to patients with complex behavioral/ mental health conditions, substance use disorders, and/or intellectual and developmental disabilities (I/DD). Required care management activities include care coordination, health promotion, transitional care planning and follow-up, family support, and referrals to necessary resources and supports. These functions may be preformed throughout WNC in community-based settings. The Tailored Care Manager will collaborate with care manager extenders (Peer Support Specialists, Community Health Workers), MAHEC clinical teams, community partners, and other regional and state stakeholders. They will report to an assigned Tailored Care Manager Supervisor.
SPECIFIC RESPONSIBILITIES:
- Conduct intake assessments and screenings and obtain necessary consents according to NCDHHS standards.
- Develop person-centered care plans, seeking guidance from supervisor and other clinical experts as needed.
- Provide self-management education as well as linkages to resources/ services supporting social and medical needs.
- Support transition planning when patients are admitted/discharged from hospitals or other institutional settings.
- Provide patient consultation in adapting treatment goals, identifying strengths, creating action items and addressing barriers to goals.
- Builds and maintains a full patient panel by actively identifying patients who qualify for program benefits and initiates outreach.
- Develops outreach and engagement strategies to engage qualified patients.
- Educates providers and clinical staff on program services, identifying qualified patients, and patient engagement tactics.
- Work with MAHEC’s Quality Improvement team to improve care management delivery and patient outcomes. Ensure care management is successfully closing care gaps and meeting quality standards.
- Collaborate with MAHEC’s clinical departments (Family Medicine, Internal Medicine, Pharmacy, OBGYN, and Psychiatry) and community resource organizations to ensure seamless care coordination/management for the population being served.
- Coordinate and may facilitate integrated Care Team meetings where patient Care Plan is discussed.
- Provide 24:7 crisis response in rotation with other team members, which includes arrangement of services, consultation, or referral followed by coordination of care to an appropriate setting when necessary.
- Create a Care Management Crisis Plan and coordinate Diversion efforts for patients at risk of admission to an institutional setting.
- Identify system barriers and collaborate to resolve issues with MAHEC departments and with community stakeholders.
This role description is a general description of the essential job functions. It is not intended to describe all the duties the Tailored Care Manager may perform.
KEY COMPETENCIES:
- Communication Skills
Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families.
- Decision Making
Ability to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.
- HealthCare Knowledge
Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate. This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC’s organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.
- Interpersonal Skills
Showing the ability to meet difficult situations with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when its most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others.
- Organizational Values
Adherence to MAHEC’s founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and equitable practices, ability to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need.
- Problem Solving
Having an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically through a difficult problem and come to an appropriate resolution for a given issue. This helps to drive continuous improvement by thinking through where we can improve in a novel way. Measures success by understanding where we are currently and where we want to go and then applying those new ideas to affect positive change.
SPECIFIED SKILLS
- COMPUTER
- Must be competent with virtual (email, Webex, Zoom, Microsoft TEAMS etc.) communication, Electronic Health Record (EHR) systems and Care Management/Coordination systems.
- FOREIGN LANGUAGE
- Fluency in Spanish preferred
PHYSICAL DEMANDS
- Not Applicable.
SUPERVISORY RESPONSIBILITIES:
- Extenders (Peer Support Specialist and/or Community Health Workers)
EDUCATION AND EXPERIENCE
- MINIMUM QUALIFICATIONS:
- Bachelor’s degree in nursing
- A licensed registered nurse
- Four (4) years of experience providing care management, case management, or care coordination to the population being served (Behavioral Health and/or I/DD)
REQUIRED LICENSES:
- Meet North Carolina’s definition of a Qualified Professional per 10A-NCAC 27G .0104
- Valid driver’s license
SCHEDULE:
This position is hybrid with some travel and routinely scheduled attendance on-site. Typical business hours are Monday – Friday, 8:00 am to 5:00 pm (or flexed to best meet the needs of the clients and/or the Division); 40 hours per workweek; weekend, holiday, or evening coverage is occasionally required. Work hours will need to be flexible in order to respond to special work assignments, or evening activities, as requested by the team leader.
POSITION COMPENSATION:
$66,900, full time with full benefits available
At MAHEC, we strive to equip all team members with Total Rewards (pay + benefits) to honor their service, support their health, manage their financial security, build their career, and thrive.
All MAHEC employees and learners will be required to receive the Flu vaccine or have an approved exemption.
MAHEC Talent Management is located at 121 Hendersonville Road, Asheville, NC 28803. Equal Opportunity Employer. Black, Indigenous, People of Color and Spanish/English bilingual persons are strongly encouraged to apply. With this in mind, studies show that women, gender diverse, and BIPOC candidates are less likely to apply unless they meet all of the qualifications listed in the job description.
If you are interested in this role, and you have related experience and qualifications, we encourage you to apply or reach out to AskTalent@mahec.net for support in your job search process. You could be the talent we are seeking for this or other opportunities.
ApplyJob Profile
Must be located in North Carolina
Tasks- Conduct intake assessments
- Coordinate care
- Develop care plans
- Engage qualified patients
- Provide self-management education
- Support transition planning
Care Coordination Communication Conflict Resolution Crisis Response Critical thinking Decision making Healthcare Knowledge Health promotion Patient Consultation Patient Engagement Quality improvement Transitional Care Planning
Experience2 years
Education TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9