Pay rate: $36.06 Hourly with competitive benefits.
The Clinical Care Manager is responsible for overseeing outreach, care coordination and RN processes in their respective region. The Clinical Care Manager will supervise Care Coordinators in providing coordinated care management services as an integrated member of the care management team to a diverse population with LTSS needs. The Clinical Care Manager is responsible for providing final review and approval of the Enrollee’s Comprehensive Assessment and Care Plan. The Clinical Care Manager maintains ongoing collaboration with the care team for review and approval of workflows and processes.
Responsibilities1. Provide overall supervision to Care Coordinators, Outreach Specialists and RNs, and ensure compliance of program requirements and regional quality metrics.
2. Hire, train and supervise Care Coordinators, Outreach Specialists and RN.
3. Motivate and lead a high-performance team; provide supervision, mentoring and professional development opportunities.
4. Collaborate with team members to implement measures that decrease episodic care and meet quality outcomes.
5. Work collaboratively and effectively with care management, including Assigned or Engaged Enrollee, medical team, and other providers to coordinate the delivery of LTSS care management services.
6. Provide final review and approval of LTSS Comprehensive Assessment and Person-Centered Care Treatment Plan. Facilitate collaborations between the RN and CC to ensure Assigned or Engaged Enrollees are receiving quality services.
7. Supervise Care Coordinators in completing comprehensive assessment and Person-Centered Treatment Plan in a collaborative manner with Assigned and Engaged Enrollees, with input from Care Team members and other stakeholders. Review and sign off on all assessments completed by Care Coordinators.
8. Work collaboratively with Operations Manager to ensure all metrics are being tracked/adhered to i.e., initial, and annual reassessment, initial and annual care plans, monthly communications, etc.
9. Ensure Comprehensive Assessments and the development of a Person-Centered Treatment Plan (PCTP) are completed within the expected timeframe as set by Contractor.
10. Ensure RNs conduct Enrollee medication reconciliation within 7 days of discharge from an inpatient stay.
11. Utilize the dashboards and database to track staff work activities including outreach, intake, assessment, service planning and delivery, referrals, and linkages to community-based organizations, follow up, collaboration with collateral contacts, documentation, confidentiality and contract standards.
12. Ensure PCTPs meet the requirements of EOHHS and ensure all updates and changes are reported to the ACO/MCO.
13. Supervise Care Coordinators in discussing advanced directives, acute care plans, and/or crisis plans with All Enrollees as needed. Supervise Care Coordinators in working with All Enrollees to assemble Care Teams and facilitate all communication and coordination with the team.
14. Supervise Care Coordinators in supporting All Enrollees during care transitions including attendance at discharge planning meetings, face to face meetings post discharge, ensuring linkages with all needed services and supports, and facilitating Enrollee participation in those services.
15. Meet expectations related to supervising the programmatically required number of Care Coordinators and supporting the programmatically required number of Enrollees which may vary over time.
16. Supervise Care Coordinators in providing health and wellness coaching to All Enrollees and assist them in identifying and utilizing health and wellness supports in the community.
17. Supervise Care Coordinators in connecting All Enrollees to all needed services and supports including those that address social needs that affect health and facilitating ongoing connection.
18. Supervise Care Coordinators in collaborating with existing providers, Care Team members, state agency staff, and all other stakeholders and delivers CP supports and activities in accordance with Enrollee’s person-centered treatment plan.
19. Participate in MCCN team meetings and each Enrollee’s Care Team with the assigned Care Coordinator when needed to ensure effective communication among all disciplines and stakeholders involved in the person’s care.
20. Identify community resources and develop natural supports for Enrollees and supervise Care Coordinators in performing these functions.
21. Participate in all required orientation and training. Train Care Coordinators and other CP Team members.
22. Learn all MCCN policies, procedures, protocols and plans and deliver CP supports and activities in compliance with them. Ensure all CP Team members are trained and comply with these protocols.
23. Develop knowledge about all focus populations and assist CP Team members in doing so.
24. Learn evidence-based practices identified by MCCN, and deliver CP supports and activities in compliance with them and ensure all CP Team members are trained and supported in implementing them.
25. Complete all required documentation in a timely manner.
26. Attend and actively participate in supervision and staff meetings.
27. Supervise and consults with RNs and other CP Team members as needed around clinical, medical and other matters.
28. Ensure that all clients are treated with dignity and respect in accordance with MCCN’s Human Rights policy.
29. Perform all duties in accordance with the agency’s policies and procedures.
30. Strictly follow all agency Performance Standards.
1. Clinical Care Manager(s) shall have at minimum at least two years of relevant professional experience working in a community-based mental health, substance use and/or physical health setting and hold at least one of the following qualifications: A licensed registered nurse (RN) with BH expertise, A licensed independent clinical social worker (LICSW), A licensed mental health counselor (LMHC), A licensed marriage and family therapist (LMFT), A licensed alcohol and drug counselor I (LADC I), A licensed psychologist, A licensed certified social worker (LCSW), A licensed rehabilitation counselor; or A registered occupational therapist.
2. Minimum of 2 years’ supervisory experience, preferred.
3. Demonstrates knowledge base and judgment necessary for independent clinical decision making.
4. Strongly prefer that a candidate will have a demonstrated understanding of and competence of Health Equity and in serving culturally diverse populations and different linguistic backgrounds.
5. Experience working with individuals in a clinical setting and/or with complex LTSS needs and credentialled as a community health worker, health outreach worker, peer specialist, or recovery coach desired. Care Coordination and Behavioral Health experience preferred.
6. Strong skills in the areas of communication, follow through, collaboration, and customer service.
7. Excellent interpersonal skills and demonstrate ability to interact professionally with culturally and educationally diverse staff and supervisees.
8. Creativity, flexibility, sound judgment, and the ability to take initiative.
9. Excellent time management and organizational skills.
10. Ability to use Electronic Health Records (EHR) Systems to document and coordinate services.
11. Strong Computer skills, including proficiency in contemporary Windows operating systems and Windows office suites with an emphasis on Word and Excel; ability to learn new systems; experience entering and working with data; and comfort and experience using mobile technologies.
12. Strong communication and writing skills.
13. Demonstrated ability to work as an effective team member and leader in a complex and fast-paced environment.
14. Must be able to perform each essential duty satisfactorily.
15. Ability to travel on a regular basis; Must have valid driver’s license and access to auto.
16. Ability to read and speak English. Fluency in other languages, preferred.
Must be able to perform sedentary aspects of position, including, but not limited to desk and electronic work, typing, driving to meetings and trainings, as well as driving/transporting clients as necessary.
Must be able to perform the duties listed above, with or without a reasonable accommodation.
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