Tribal Option Care Manager Specialty Lead

Job Description

Job Description:\n\n Job Title: Tribal Option Care Manager Specialty Lead Job Code: TO CMSL Department: Primary Care Division: Nursing Salary Level: Non-Exempt 13 Reports to: Tribal Option Care Manager Supervisor/Assistant Director of Care Management/Director of Care Management Last Revised: July 2025 Primary Function The Tribal Option Specialty Team Care Manager Lead will be responsible for providing oversight and will be assigned to one of the three Tribal Option Specialty Teams who provides proactive intervention and care coordination to members who are eligible for Tribal Option to ensure that these individuals receive the appropriate assessment and services. The three Tribal Option Specialty teams are I/DD/TBI/LTSS, Adults and Children with Special Health Care Needs, and Children and Families served by the child welfare system. The TO Specialty Team CM Lead is a long-term role, requiring clinical, behavioral health and interpersonal skills. The TO Specialty Team CM Lead collaborates with the Tribal Option Care Manager Supervisor, Assistant Director of Care Management and Director of Primary Care Nursing and Care Management on clinical and non-clinical issues (employee relations, individual behaviors, physician relationships, etc.). The TO Specialty Team CM Lead is the support for the TO Care Management team when the Tribal Option Care Management Supervisor, Assistant Director of Care Management and Director of Primary Care Nursing and Care Management is unavailable. The TO Specialty Team CM Lead is responsible for supervising, directing, coaching and mentoring their assigned core group of staff. The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description. The overall goal of the Care Management model is improved health outcomes for eligible individuals. The design of the model has been shaped by the following guiding principles:Broad access to care management. Care Management is available to all eligible individuals continuously, with limited exceptions.Dedicated care manager taking an integrated, whole-person approach. To the maximum extent possible, each enrolled individual will receive integrated, whole-person care management from a dedicated care manager with expertise and training in addressing behavioral health, I/DD, LTSS and/or TBI needs in addition to physical health needs and unmet health-related resource needs. Person and family-centered planning. Care planning for individuals will be person-centered and will consider their unique needs. Parents, other family members, and caregivers can also serve as part of the individual’s care team, with the individual’s consent. Tribal Option Care Management aligns with the North Carolina System of Care framework. Job DescriptionPlan and assist with coordination of staff schedules and submit to the Tribal Option Care Manager Supervisor for approval.Plan and coordinate requirements for staff and ensure that all competencies and requirements for Tribal Option staff are currently utilizing best practice models to identify, incorporate or develop best practices for panel management.Coordinate requirements with staff regarding equipment and supplies.Consult with preceptors and orientees on a regular basis to provide support and determine how orientation should proceed on an individual basis.Collaborate with the RN Care Manager Supervisor, Tribal Option Care Management Supervisor, Assistant Director of Care Management, and Director of Nursing for Primary Care and Care Management for issue resolutions and projects to improve work flow processes throughout the department utilizing a quality improvement/LEAN approach.Collaborate with different departments (pharmacy, radiology, lab, registration) to resolve issues and improve work flow processes throughout the department.Collaborate/plan/implement the interview process for new applicants.Mentor and monitor the preceptors for all new employees.Mentor/coach staff to enhance their professional development.Responsible for learning, implementing and teaching new technology/procedures.Facilitates assignments that support learning for the orientee or nursing staff.Assess staffing needs according to workload and staff competency; Re- assigns and adjusts staffing based upon patient care needs.Delegates responsibilities within the scope of practice and validated competencies in order to meet the workload demands of the shift.Promotes an atmosphere of open communication that facilitates staff input into decision-making, resolution of conflict, quality improvement and collegiality among all health team members.Facilitates staff performance audits related to attitude, team performance, Tribal Option management quality Metrics and the EBCI TO Clinical PIP.Facilitates and encourages staff participation in departmental and hospital quality improvement efforts and committees.Attends departmental and hospital committee meetings as assigned.Coordinates, facilitates, participates and directs departmental projects with follow-through and appropriate follow-up.Other projects and duties as directed by the department managers.Oversight of care managers providing care management activities to members eligible for Tailored Care BH transition of Care as set for by NCDHHS contractDemonstrates awareness of current problems and basic plan for all patients/members within care management.Communicates in an effective, professional manner.Auditing of work of the care managers within the team.Completing the care managers PAS and providing guidance and corrective action when needed.Helping with guidance with complicated membersEnsure that transition planning is occurring and a care manager is assigned to manage the transition.Ensure that the assigned care manager follows up with the Member within forty-eight (48) hours of discharge or use of a crisis service, to the maximum extent possible. Facilitate coordinated care with the Vaya or other Tailored Plan care managers, where applicableCarrying a small empanelment of members which may include the duties as defined by the Tribal Option Care Manager/Tribal Option Specialty Team Care Manager position description.Responsible for assisting with establishing a multidisciplinary care-teams for each member.Coordinates closely with each member’s primary care provider (PCP), and, as appropriate, care manager extenders, assigned County Child Welfare worker, EBCI Family Safety Program staff, CIHA Care Team, family members and guardians to manage the member’s health care needs.The care manager will make best efforts to contact the member during their stay in an inpatient psychiatric unit or hospital, Facility-Based Crisis, general hospital unit, or nursing facility and make best effort to contact the member on the day of discharge.Provides transitional care management during care transitions (including assisting individuals with transitioning from congregate or other intensive treatment settings to a foster care home or other community placement).Facilitate clinical handoffs.Responsible for ensuring members receive robust medication reconciliation and management. Assists the member in obtaining needed medications prior to discharge, ensure an appropriate care team member conducts medication reconciliation/management, and support medication adherenceDirects the extender’s care management functions and ensure that the extender supports allowable activities (e.g., coordinating services/appointments by arranging transportation, etc.).Responsible for implementing the Healthy Opportunities Pilot (HOP) program for its HOP-eligible membersMonitor for HCBS compliance and Notify Tailored Plan / LME/MCO of updates to eligibility and/or need for 1915(i) services.Monitor ISP implementation and resolve or escalate issues as neededMonitor at least quarterly to ensure that any restrictive interventions (including protective devices used for behavioral support) are written into the Care Plan/ISP and the Positive Behavior Support Plan; Utilizes best practice models to identify, incorporate or develop best practices for panel management. Collaborates with other teams to share and establish best practice for health promotion and disease prevention strategies.Provides appropriate follow up as directed or per established guidelines.Responsibility of the six core Health Home Services for the tailored planMay be required to provide 24/7 support during emergencies or behavioral health crises to secure immediate treatment services, as needed.Responsible for convening the care team on a regular basis (no less than twice per year, and more often, as appropriate) and will share the care plan/ISP with the member’s care team and other representatives, as appropriate, to support delivery of the member’s needed health and health-related services.Required to coordinate closely with each member’s assigned County Child Welfare worker to share relevant health and health-related informationCollaborate with County Child Welfare workers as needed in the development of the NCDSS-required transitional living plan and 90-day transition plan.May be subject to on-call and callback.May be necessary to work when administrative leave is granted if patient care would be compromised.The incumbent will be evaluated annually on his/her ability to identify, assess, analyze, and evaluate data and solve problems through the CIH Performance Appraisal System. Education/Experience/Minimum Qualifications Care Managers serving all members must have the following minimum qualifications:Meet North Carolina’s definition of a Qualified Health Professionalper 10A-NCAC 27G. 0104"Qualified professional" means within the mh/dd/sas system of care either:An individual who holds a license, provisional license, or certificate issued by the governing board regulating a human service profession, including a registered nurse who is licensed to practice in the State of North Carolina by the North Carolina Board of Nursing who also has four years of full-time accumulated experience in mh/dd/sa with the population servA graduate of a college or university with a Masters degree in a human service field and has one year of full-time, pre- or post-graduate degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has one year of full-time, pre- or post-graduate degree accumulated supervised experience in alcoholism and drug abuse counseling;A graduate of a college or university with a bachelor's degree in a human service field and has two years of full-time, pre- or post-bachelor's degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has two years of full-time, pre- or post-bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling; orA graduate of a college or university with a bachelor's degree in a field other than human services and has four years of full-time, pre- or post-bachelor's degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has four years of full-time, pre- or post-bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling.For care managers serving members with LTSS needs: two years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience, in addition to the requirements cited above. (This experience may be concurrent with the two years of experience working directly with individuals with behavioral health conditions, and I/DD or TBI conditions above).Supervising care managers serving members with behavioral health conditions must have the following minimum qualifications: A license, provisional license, certificate, registration or permit issued by the governing board regulating a human service profession (including Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Addiction Specialist (LCAS), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Psychological Associate (LPA)), or a Registered Nurse (RN) license issued by the North Carolina Board of Nursing; ANDThree years of experience providing care management, case management, or care coordination to the population being served. Supervising care managers serving members with an I/DD or a TBI must have one of the following minimum qualifications: A bachelor’s degree ANDFive years of experience providing care management, case management, or care coordination to complex individuals with I/DD or TBI; ORA master’s degree in a human services field ANDThree years of experience providing care management, case management, or care coordination to complex individuals with an I/DD or a TBI.AND in addition to the conditions aboveSpecific experience working with Native Americans preferred.Current Basic Life Support (BLS) minimally required. Can be acquired through the facility within 6 months following appointment to position.Applicant must have a valid North Carolina driver’s license. Job KnowledgeKnowledge and ability to independently plan, manage, and organize work in order to meet priorities, accomplish work within established time frames and work in stressful situations.Knowledge of the occupational functions of multi-disciplinary health care team.Knowledge of the culture and medical health profile of the patient population.Knowledge and ability to teach and counsel patient/family on health maintenance and disease prevention.Knowledge of available health care programs and community resources.Knowledge of processes and procedures for establishing, revising, continually monitoring, and evaluating standards for the practice of care management.Knowledge of problem oriented medical record methods.Knowledge of legal and ethical aspects of care management.Knowledge of the tailored care plan requirements and additional care management activities for this selected group of membersHave a working knowledge of care management including screenings, assessments, development of care plans and knowledge of resources available to members at all levels including tribal, county, regional and state.Have a working knowledge of the special needs of members who fall into the category of being eligible for Tailored Care which includes those members with care needs related to a behavioral health condition (including both mental health and substance use disorders), intellectual/developmental disability (I/DD), or traumatic brain injury (TBI). Or have the training and evidence of ability to perform these duties for members eligible for the tailored plan.Exhibit a