Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Care Management Health Screenings Care Coordination Care Coordination Care Planning KPI Reporting Educational Outreach Electronic Referrals Software Documentation Transitional Care +4 more

Other Skills

•
Microsoft Office
•
Decision Making
•
Communication
•
Multitasking
•
Time Management
•
Solutions Focused
•
Stress Management
•
Detail Oriented
•
Social Skills
•
Diplomacy

Roles & Responsibilities

Bachelor's degree in health-related fields (health, psychology, sociology, social work, or nursing) or RN licensure, plus two years of care management/case management/care coordination experience with complex individuals with BH, I/DD or TBI; OR Bachelor's in a non-human services field with four years of similar experience
Two years of prior Long Term Support Services and/or Home and Community Based Standards coordination and care management experience
Must reside in North Carolina (RN licensure, if applicable, must be NC)

Requirements:

Outreach to members via phone to field questions, educate on Tailored Care Management approaches, and assist with requests to change Care Managers or Opt-out
Complete initial and annual Care Needs Screenings; coordinate care and transitional care as needed; engage members who are ineligible for, or opted out of, Tailored Care Management
Collaborate with PCCM Vendor and other care management entities; respond to care management inquiries within defined timelines; share assessments and care plans with relevant entities
Accept care coordination referrals, determine level of required services, provide referral status feedback within five business days, and initiate referrals to the PCCM vendor with documentation

Partners Health Management

About Partners Health Management

You will often hear people call Partners a North Carolina local management entity/managed care organization or LME/MCO. We think of ourselves as an MCO…a Member Care Organization™. Partners manages Medicaid, state and local funds for mental health, intellectual/developmental disability, substance use disorder and traumatic brain injury services. The system of care we manage is shaped by the choices of our members and their families and designed to meet the unique needs of each of the communities we serve. Partners manages care in Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Surry, Stanly, Union and Yadkin Counties. Our Crisis Line is available all day, every day at 1-888-235-HOPE (4673). Learn more about us at www.PartnersBHM.org.

Company type: SME

Founded: 2018

Company size: 201 - 500

Website LinkedIn See all jobs →

Job description

Competitive Compensation & Benefits Package!

Position eligible for –

Annual incentive bonus plan
Medical, dental, and vision insurance with low deductible/low cost health plan
Generous vacation and sick time accrual
12 paid holidays
State Retirement (pension plan)
401(k) Plan with employer match
Company paid life and disability insurance
Wellness Programs
Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details.

Office Location: Remote position; Available for any of Partners NC locations

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of Position: The Screening and Referral Specialist performs intermediate administrative work as well other qualified professional duties related to overseeing the coordination and management of care for members and recipients. The Screening & Referral Specialist is responsible for providing outreach, screening and care coordination for members not receiving Tailored Care Management. Support provided is telephonic or via two-way audio-visual contact with referral to community-based teams when indicated for transitional care. The Screening and Referral Specialist will assist members and recipients with requests to change Care Managers, Opt-out, or engage/re-engage with Care Management.

This position requires perseverance in efforts to locate and contact members and will require flexibility in work hours, with some early evening hours required in order to effectively contact as many members as possible to engage them in Tailored Care Management or complete Care Needs Screenings. This position will ensure accurate documentation in NCFAST portal regarding Care Manager assignment. This position will complete Care Needs Screenings for members who are ineligible for Care Management or have chosen to Opt-Out. . This position will assist with securing and monitoring Care Coordination efforts for recipients enrolled in state benefits. This position is a member of the Care Connection Team. This is a mobile position with work done in a variety of locations.

Role and Responsibilities:

The Screening & Referral Specialist is responsible for (though not limited to):

Outreach for Members Communicate with members and recipients via phone to field questions and provide education on the TCM approaches, request to change CM process, and Opt-out process

Care Needs Screenings / Care Coordination

Coordinate a range of scenarios, which require a wide array of potential responses including, but not limited to informing, researching, linking, assessing need, reviewing documentation, phone communication, and consultation.
Complete initial Care Needs Screenings for members who are ineligible to receive TCM due to receiving a service which is duplicative or excluded
Complete initial and annual Care Needs Screenings for members who have opted out of receiving TCM, again providing opportunity for engagement in TCM
Connect members not participating in TCM with transitional care as necessary
Communicate with members and recipients via phone to field questions and provide education on the TCM approaches, request to change CM process, and Opt-out process

Collaboration with Primary Care Case Management (PCCM) Vendor (currently CCNC) and Other Care Management Entities

Be responsive to requests from other entities providing care management to members ineligible for Tailored Care Management
Receive and respond to inquiries from PCCM care managers, and any other care or case manager assigned to or responsible for a member, with quick provision of help to callers (within 24 hrs for urgent situations, within 3 business days for non-urgent situations)
Check the PCCM Care Management Information System to determine whether the member is also being managed by a PCCM care manager.
Coordinate with each member’s care manager as needed to the extent the member is engaged in care management through another entity (e.g., PCCM Vendor, Skilled Nursing Facility, CAP/C or CAP/DA, etc.)
Share the results of the any assessments conducted, the member’s person-centered plan, and the member’s Care Plan (to the extent one exists) with entity providing care management
Link member with Partners transitional care team or community care management team
Accept care coordination referrals from primary care providers and care managers from other entities, determine what level of care coordination services are needed, and provide referral status feedback to the referring provider or care manager within five (5) business days.
Initiate care management and physical health referrals to the PCCM vendor as such needs are identified and receive and document feedback from the PCCM vendor regarding the referral status.

Documentation/Other Duties

Ensure accurate documentation in TruCare and Alpha+ regarding Care Manager assignment
Assist in identification of barriers to case load management and in development of strategies to address said barriers
Track and report performance measures to supervisor as assigned.
Document accurately, comprehensively, and timely all contacts and other care coordination functions
Facilitate the integration of continuous quality improvement
Perform related tasks as assigned
Ensure that work hours are adjusted, when necessary, to maximize successful contacts with members

Other requirements:

Must have ability to travel as needed to attend required in-person meetings/trainings.

Knowledge, Skills and Abilities:

Knowledge of Tailored Plan, NC Medicaid Direct, and state funded benefits
Comprehensive knowledge of care needs screening timelines and processes for both Tailored Plan and Medicaid Direct contracts
Exceptional interpersonal and communication skills
Excellent computer skills including proficiency in Microsoft Office products (Word, Excel, Outlook, and PowerPoint)
Detail-oriented, able to organize multiple tasks and priorities and effectively manage projects from start to finish
Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships
Ability to change the focus of his/her activities to meet changing priorities
A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance
Skill and ability to demonstrate diplomacy as well as the ability to handle stressful situations
Ability to demonstrate initiative and effective, solution-focused, problem-solving skills
Ability to assess personal strengths/needs and identify needed training to promote own professional development

Education/Experience Required:

Bachelor’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area or licensure as an RN; and two (2) years of experience providing care management, case management, or care coordination to complex individuals with BH, I/DD or TBI; OR
Bachelor’s degree in a non-human services field and four (4) years of experience providing care management, case management, or care coordination to complex individuals with BH, I/DD or TBI.

AND

Two (2) years of prior Long Term Support Services and/or Home and Community Based Standards coordination, care delivery monitoring and care management experience. This experience may be concurrent with years of experience working directly with individuals with BH, I/DD, or a TBI, as described above.

AND