Primary Function

The Tribal Option Specialty Team Care Manager Lead will be responsible for providing oversight and will be assigned to one of the 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 specialty teams consist of Care Managers who provide Tribal Option Care Management Services for all eligible members that include: I/DD/TBI, Adults and Children with Special Health Care Needs, LTSS, Children and Families served by the child welfare system, High Risk Care Management and Care Coordination.

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 Description

• Plan 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 contract
• Demonstrates 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 members
• Ensure 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 applicable
• Carrying 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 adherence
• Directs 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 members
• Monitor 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 needed
• Monitor 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 plan
• May 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 information
• Collaborate 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 CIHA Performance Appraisal System.

Education/Experience/Minimum Qualifications

• All Supervising Care Managers serving members must have the following minimum qualifications: Meet North Carolina’s definition of a Qualified Health Professional per 10A-NCAC 27G. 0104
  • "Qualified professional" means within the mh/dd/sas system of care either:

1. 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 served.
2. A graduate of a college or university with a Master’s 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;
3. 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; or
4. A 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.

• Supervising 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;
• AND
• Three 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
• AND
• Five years of experience providing care management, case management, or care coordination to complex individuals with I/DD or TBI;

• OR
  • A master’s degree in a human services field
  • AND
  • Three years of experience providing care management, case management, or care coordination to complex individuals with an I/DD or a TBI.
• OR
  • Licensure as an RN
  • AND
  • Three 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 above:
  • Nurses Must have an unrestricted valid Registered Nurse license within the state of North Carolina or a state that is accepted as reciprocity.
  • Specific 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 Knowledge

• Knowledge 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 members
• Have 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 an extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and have considerable knowledge of the MH/SUD/DD service array provided through the network of providers, internal and external to the EBCI health system. Additional knowledge in Medicaid 1115, B and C waivers as well as, innovations and 1915i waivers and other accreditation bodies is essential.
• Ability to ascertain the potential lethality of a situation and respond and refer accordingly.
• Ability to master care management platforms and review data for decision making and person-centered planning
• Knowledge of a wide range of medical, behavioral and psychosocial problems and their treatment.
• Knowledge of governmental and private organizations and resources in the community.
• Knowledge of the laws, regulations, and policies, which govern the program.
• Knowledge of medical terminology, disease processes, and their treatment as they relate to decisions regarding clinical interventions and appropriate therapies based on medical or psychological diagnosis
• When carrying a small empanelment of members which may include the duties as defined by the Tribal Option Care Management position description
• In addition, 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)
• Knowledge of the assessment, person-centered planning and thinking, treatment and support of IDD/TBI/LTSS, with or without co-occurring behavioral health and other chronic conditions, is a necessity.
• Knowledge is required of and to have expertise in the systems and tools that are fundamental to the transition to adulthood, including independent living skills (e.g., accessing food and transportation), post-high school education, housing and employment options, self-advocacy, health insurance coverage options after Medicaid eligibility ends and building natural supports.
• Knowledge of ISP/Care Plan development and implementation for members of EBCI Tribal Option (TO) that are tailored plan eligible including the following:
• Knowledge of using assessments to develop plans of care
• Knowledge of LOC process, SIS for IDD and FASN assessment for TBI
• Knowledge of Medicaid basic, enhanced MH/SUD, and waiver benefits plans
• Knowledge of and skilled in the use of Motivational Interviewing and techniques
• Person Centered Thinking/planning
• Strong interpersonal and written/verbal communication skills
• Conflict management and resolution skills
• Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
• Ability to master care management platforms and review data for decision making and person-centered planning
• High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
• Ability to make prompt, independent decisions based upon relevant facts
• Good organizational skills to prioritize duties and work with minimal levels of onsite supervision to consistently meet deadline
• Skill in establishing rapport with a member and in applying techniques of assessing psychological, behavioral, and psychosocial aspects of member/patient’s problems when assessing members for care needs or gaps in care.
• Willingness to learn more about Cherokee culture/population and to have considerations for this when identified.
• Ability to establish and maintain effective working relationships with members of and their families, other professional disciplines, and a variety of governmental and private resources and organizations in the community.
• Ability to express ideas clearly and concisely and to plan and execute work effectively.
• Ability to work from home in certain circumstance and still be effective in providing care management activities

Complexity of Duties

This position is responsible for assisting in maximizing the available resources to meet the needs of the community. Must have the ability to interpret policy, laws and regulations in order to make decisions. Duties require the application of clinical judgment and problem- solving skills in order to be effective.

Supervision Received

The incumbent independently plans, schedules, and provides care in coordination with the medical care plan and Tribal Option Care plan and attempts to solve problems only within established procedures. This is done under the supervision of the Tribal Option Care Manager Supervisor, the Assistant Director of Care Management, and the Director of Care Management. The work is evaluated for technical soundness and adherence to professional standards.

Responsibility for Accuracy

Failure to provide adequate clinical services or to properly manage and direct activities could result in poor client outcomes, delays in patient treatment, and negative patient and community relations. Ineffective health planning could have adverse effects on the health status of the community by limiting access to necessary resources. Accuracy of data and research is critical in the allocation of tribal resources. Employee is responsible for the adherence to policy and procedure.

Contact with Others

Interacts frequently with coworkers, hospital staff, patients, stakeholders and other health professionals for the purpose of exchanging information, obtaining, or providing assistance. Serves on various local, community, and health committees, boards and advisory councils, as appropriate. Tact, courtesy, and professional conduct are required to maintain positive working relationships. Utmost sensitivity and confidentiality is required when dealing with patients and families.

Confidential Data

The provision of medical care requires that the incumbent maintain strict confidentiality regarding all patient information. The employee will have access to patient records and highly confidential information and must function with utmost integrity to safe guard this information. The employee complies with EBCI policy on confidentiality of patient records, Cherokee Indian Hospital Authority Confidentiality policy, HIPAA, 42CFR and other federal law requirements. Violations of confidentiality regulations may result disciplinary action and other action as allowed by federal regulations.

Mental/Visual/Physical Environment

Job duties can be mentally and emotionally stressful at times given the complexity of the duties. Close mental concentration and attention to detail are required. Physical activities require the ability to be mobile, sit, reach, bend, and be in front of groups and deliver training for extended periods of time. Some physical exertion and stamina is required such as required to transport training materials or to travel. Must be able to lift 30 lbs.

Work Environment

Must be flexible in working hours. This position offers a hybrid work model, with the flexibility to work remotely or from the designated work space. Specific workdays and location will be determined in collaboration with the team, the Tribal Option Care Manager Specialty Lead, and Tribal Option Care Manager Supervisor. The incumbent may occasionally be required to perform care management duties and tasks within the clinical setting. incumbent is required to comply with Employee Health Program guidelines including current immunization status of identified communicable diseases and safety precautions are sometimes necessary, such as use of personal protective equipment as required by hospital policy. The work environment involves moderate risks of exposure to infectious disease, radiation, electrical hazards, irritant chemicals and explosive gases.

Some travel is required. Infrequent overnight travel may be required for meetings or to attend training.

Customer Service

Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.