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JOB DESCRIPTION & PHYSICAL REQUIREMENTS
Director of Tailored Care Management
Carobell, Inc. Tailored Care Management
Revision Date(s) and Description of Revision
Reviewed and Approved by
Scope of Position
The Tailored Care Management Director will be responsible for the oversight and structure of the organizations Tailored Care Management Model. He/she will regularly communicate and collaborate with the organizations leadership to support Carobell, Inc. mission.
Essential Job Functions
- Participates in the screening, hiring, orientation, training, and performance evaluation of care management staff with expertise and training in addressing I/DD, and/or TBI needs in addition to physical health needs and unmet health-related resources needs.
- Ensures that the organization has the appropriate structures in place to oversee the Tailored Care Management Model.
- Communicates, collaborates, and works directly with the Carobell’s Leadership to support Carobell, Inc. mission.
- Capacity building
- Ensures that beneficiaries are assigned and risks stratified by care management staff
- Manages day to day operations of the tailored care management department
- Ensures all operational, administrative, and compliance functions within the department are being properly executed in accordance with regulatory-based best practices.
- Assists with clinical needs within the department as it relates to patient care, as needed.
- Provides clinical support to tailored care management staff and patients, as needed.
- Participates in continuous performance improvement.
- Responsible for ensuring that all data requirements are met by working with Carobell, Inc. IT Department
- Always maintains a professional working environment within the organization and encourages team-building relationships among staff in all areas.
- Fosters service excellence to ensure patient, provider, and employee satisfaction.
- Oversees safe and risk-free environment according to policies and guidelines as applicable by local, state, federal, and accrediting agencies.
- Develops and submits staffing, expense, and capital budgets annually.
- Consults with behavioral health and medical providers as needed to ensure quality of care and positive patient experience within the practice.
- Works to build active, working relationships with community providers.
- Is a role model for staff by adhering to the stated mission, vision, and values of the organization
- Responsible for assuring the most rapid and highest quality encounter given financial and other constraints.
- Will perform routine assessments of the department’s productivity and work in conjunction with other supervisors in best use of departments’ capacity
- Assists with promoting collaboration for the patient’s continuum of care with all members.
- Promptly submits accurate time records as required.
- Holds regular colleague meetings/trainings to maintain open communication.
- Participates in case review during huddles
- Other duties as assigned.
- All other duties as assigned.
Qualifications – Education, Training, and/or Experience
Knowledge and Competencies:
- Demonstrates passion and commitment to excellence
- Understands and is able to apply principals of Care Management and Person-Centered Service Planning
- Is able to understand and apply coverage guidelines and benefit limitations
- Familiar with clinical needs and disease processes for IDD, TBI, Innovation Waiver, and Co-Occurring IDD/Behavioral Health diagnosis in an ethnically diverse, dual-eligible population
- Understands and adapts appropriately to issues related to communication, cognitive or other barriers
- Ability to lead an interdisciplinary care team
- Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner
- Comfortable with conducting home visits and commuting within the service area
- Possesses basic computer skills and demonstrates a willingness to learn more advanced skills
- A master’s degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area, or licensure as a registered nurse (RN); and
- Two years of experience working directly with individuals with behavioral health conditions (if serving members with behavioral health needs) or with an I/DD or a TBI (if serving members with I/DD or TBI needs); and
- 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 a TBI, above.)