Case Manager I (R&D)

General Summary

Under the direction of the Supervisor, Case Management Services, the Case Manager provides culturally competent and trauma informed services to all consumers, assists consumers to design and implement strategies for obtaining services and supports that are goal-oriented and individualized. A Case Manager shall be responsible for assessment, planning, linkage, advocacy, coordination, and monitoring to assist consumers in gaining access to needed health and dental services, financial assistance, housing, employment, education, social services, and other services and natural supports developed through the person-centered planning process. The Case Manager incorporates LifeWays mission, vision, and values into all decision-making processes.

Essential Functions

When working with consumers needing case management services:
1. Assures that the person-centered planning process takes place and that it results in the individual plan of service (IPOS) as appropriate based on the medical necessity of the individual.
2. Assures that the plan of service identifies what services and supports will be provided, who will provide them, and how the case manager will monitor (i.e., interval of face-to-face contacts) the services and supports identified under each goal and objective.
3. Oversees implementation of the individual plan of service, including supporting the consumers dreams, goals, and desires for optimizing independence; promoting recovery; and assisting in the development and maintenance of natural supports.
4. Assures the participation of the consumer on an ongoing basis in discussions of their plans, goals, and status.
5. Identifies and addresses gaps in service provision as well as monitoring under- and over-utilization of authorizations.
6. Coordinates the consumers services and supports with all providers, making referrals, and advocating for the consumer.
7. Assists the consumer to access programs that provide financial, medical, and other assistance such as home help and transportation services.
8. Assures coordination with the consumers primary and other health care providers to assure continuity of care.
9. Coordinates and assists the consumer in crisis intervention and discharge planning, including community supports after hospitalization and or consumers with AOT, and NGRI status order in place.
10. Facilitates the transition (e.g., from inpatient to community services, school to work, dependent to independent living) process, including arrangements for follow-up services.
11. Assists consumers with crisis planning.
12. Provide Coordination of care for consumers involved in court system with active AOT and NGRI.
13. Identifies the process for after-hours contact.
When working with consumers needing supports coordination services:
14. Assures all necessary supports and services are provided to enable the consumer to achieve community inclusion and participation, productivity, and independence in home and community-based settings.
15. Assists with access to entitlements and/or legal representation.
16. Conducts brokering of providers of services/supports.
17. Develops an IPOS using person-centered planning process, including revisions to the IPOS at the consumers request or as the consumers changing circumstances may warrant.
18. Linking to, coordinating with, follow-up of, and advocacy with all supports and services, including the Medicaid Health Plan, Medicaid fee for service, or other health care providers.
19. Monitors Habilitation Supports Waiver and other mental health services.
20. Ensures planning and/or facilitating planning using person centered principles. This function may be delegated to an independent facilitator chosen by the consumer.
21. Maintains regular and predictable attendance.
Other Duties:
22. Performs all duties as assigned or requested to ensure the Case Management department runs efficiently and effectively.
23. Duties include but are not limited to: Assessment, , Person-Centered Planning, crisis intervention, and care coordination as applicable by staff credentials.
24. Duties are to be performed in the community including but not limited to consumer homes.

NOTE: The lists of essential and additional functions are not exhaustive. They may be supplemented as necessary from time to time.

Key Performance Indicators (KPIs)

Performs an average of 50 face-to-face (billable) encounters per month (150 encounters per quarter).
Produces an average of 40 T1040s per month (120 T1040s per quarter).All mandatory trainings are completed by their due date.

Competencies (SAMHSA-HRSA Center for Integrated Health Solutions)

Interpersonal Communication The ability to establish rapport quickly and to communicate effectively with consumers of healthcare, their family members, and other providers. Examples include active listening; conveying information in a jargon-free, non-judgmental manner; using terminology common to the setting in which care is delivered; and adapting to the preferred mode of communication of the consumers and families served.
Collaboration & Teamwork The ability to function effectively as a member of an interprofessional team that includes behavioral health and primary care providers, consumers, and family members. Examples include understanding and valuing the roles and responsibilities of other team members, expressing professional opinions, and resolving differences of opinion quickly, providing and seeking consultation, and fostering shared decision-making.
Screening & Assessment The ability to conduct brief, evidence-based and developmentally appropriate screening and to conduct or arrange for more detailed assessments when indicated. Examples include screening and assessment for: risky, harmful, or dependent use of substances; cognitive impairment; mental health problems; behaviors that compromise health; harm to self or others; and abuse, neglect, and domestic violence.
Care Planning & Care Coordination The ability to create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of information among consumers, family members, and providers. Examples include assisting in the development of care plans, whole health, and wellness recovery plans; matching the type and intensity of services to consumers needs; providing patient navigation services; and implementing disease management programs.
Intervention The ability to provide a range of brief, focused prevention, treatment and recovery services, as well as longer-term treatment and support for consumers with persistent illnesses. Examples include motivational interventions, health promotion and wellness services, health education, crisis intervention, brief treatments for mental health and substance use problems, and medication assisted treatments.
Cultural Competence & Adaptation The ability to provide services that are relevant to the culture of the consumer and their family. Examples include identifying and addressing disparities in healthcare access and quality, adapting services to language preferences and cultural norms, and promoting diversity among the providers working in interprofessional teams.
Systems Oriented Practice The ability to function effectively within the organizational and financial structures of the local system of healthcare. Examples include understanding and educating consumers about healthcare benefits, navigating utilization management processes, and adjusting the delivery of care to emerging healthcare reforms.
Practice-Based Learning & Quality Improvement The ability to assess and continually improve the services delivered as an individual provider and as an interprofessional team. Examples include identifying and implementing evidence-based practices, assessing treatment fidelity, measuring consumer satisfaction and healthcare outcomes, recognizing and rapidly addressing errors in care, and collaborating with other team members on service improvement.
Informatics The ability to use information technology to support and improve integrated healthcare. Examples include using electronic health records efficiently and effectively; employing computer and web-screening, assessment, and intervention tools; utilizing telehealth applications; and safeguarding privacy and confidentiality.

Job Specifications (Knowledge, Skills, and Abilities)

Knowledge
Knowledge of community mental health
Knowledge of current practices, methods, and procedures in the delivery of behavioral health services, diagnosis, and treatment.
Knowledge of credentialing status in order to perform duties within their scope.
Knowledge and understanding of all regulations, contract requirements, standards applicable to performance of duties.
Working knowledge of resources, including but not limited to: Diagnostic Criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM), Medicaid Provider Manual, LifeWays Provider Manual, Michigan Department of Health and Human Services (MDHHS), International Classification of Diseases (ICD), LifeWays Policies and Procedures, LifeWays Process Alerts, Electronic Medical Record (EMR), Physicians Desk Reference (PDR), and departmental processes.
Skills
Excellent interpersonal skills in order to establish and maintain effective working relationships with a variety of stakeholders (consumers, professionals, community members).
Skill in concurrent/collaborative documentation of services.
Excellent time management skills in a setting with potential frequent interruptions; ability to coordinate multiple concurrent duties and perform tasks in an organized and timely manner, with attention to detail.
Proficient in computer applications including Microsoft Office Suite (Word, Excel, PowerPoint, Outlook), Electronic Medical Record, LifeWays Intranet, and Internet applications.
Abilities
Ability to maintain credentialed status to perform duties. Ability to work in high-pressure, high-stress situations and a fast-paced environment. Ability to use good judgement to arrive at sound clinical decisions. Ability to learn quickly, ability to adjust to changes in job assignment, methods, personnel, or surroundings. Ability to communicate effectively in both oral and written form.