Case Management Navigator

About the role

Work in conjunction with the Care Manager to deliver integrated, whole-person care management addressing a member's physical health, behavioral health, intellectual/developmental disability (I/DD), traumatic brain injury (TBI), long-term services and supports (LTSS), and/or pharmacy needs, in addition to unmet health-related resource needs. Provide services in accordance with care management service requirements set by the state and company.

Responsibilities

• Supports Care Managers in delivering care management
• Engages the member/family/guardian with professionalism, compassion, and purpose through telephonic and virtual methods and in-home visits as required. Interactions should be concise, respectful, in a language of his/her choice, and non-judgmental
• Establishes a professional rapport with all team members, stakeholders, peers and supervisors
• Initiates the first contact with the member/family/guardian to complete the preliminary questionnaire
• Communicates with the Case Manager any information pertaining to the care and well-being of the member/family/guardian
• Provides documentation of billable events that align with minimum contact expectations to the Care Manager
• Maintains an accurate, up-to-date electronic information data stream on all interactions, encounters, activities, and communications with the member/family/guardian
• Performs general outreach, engagement, and follow up with members, to encourage accomplishment of goals set in the Plan/ISP
• Coordinates services/appointments
• Engages in health promotion activities and knowledge sharing
• Shares information with the Care Manager and other members of the care team on the member's circumstances
• Provides and tracks referrals and provides information and assistance in obtaining and maintaining community-based resources and social support services
• Participates in case conferences and planning meetings
• Supports the Care Manager in identifying and addressing barriers to services, gaps in service, and unmet health-related needs proactively, expanding relationships and linkages to aid in meeting member's needs
• Provides services that meet national, state, and local healthcare standards at the highest level
• Reports issues of concern, general departmental activities and staffing needs to the Care Manager
• Completes all required training and participates in educational sessions to improve overall skills
• Attends industry meetings, training, and functions to promote positive relationships with stakeholders
• Participates in quality improvement and measurement activities to achieve identified targets and outcomes
• Performs other related duties and activities as required

Qualifications

• At least 18 years old
• High School Diploma or G.E.D equivalent
• Be a person with lived experience with an I/DD or a TBI with demonstrated knowledge of and direct personal experience navigating the North Carolina Medicaid delivery system; or, a parent or guardian of an individual with an I/DD or a TBI and has at least two years of direct experience providing care for and navigating the Medicaid delivery system on behalf of that individual (parent/guardian cannot serve as an extender for their family member); or, has two years of paid experience performing functions in this job description with at least one year of paid experience working directly with the Tailored Care Management eligible population
• Must meet all agency requirements for pre-employment and those required by state
• Trained in Tailored Care Management preferred
• Ability to perform work with a high degree of quality and autonomy
• Travel as needed

Physical requirements

Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.