Director- Tailored Care Management

Position Overview
Staff in this position is responsible for day-to-day operation of Tailored Care Management Services and serves as the Supervising Care Manager to ensure and provide oversight for all clinical as well as operational service requirements of this service. Is responsible for supervision of staff per organization chart. This position reports directly to the Regional Service Director.
Essential Duties & Responsibilities
Administrative:
Is responsible for the clinical management and oversight of the Tailored Care Management Services and its staff.
Maintains < 1 supervisor to 8 TCM Care Manager ratio.
Ensures programmatic compliance with all CMS and NCDHHS standards related to Tailored Care Management Services.
Ensures compliance with ComServ, Inc. personnel policies related to hiring, suspending, and separation of employment in coordination with HR Department.
Ensures generalized agency and Care Management Services training is completed as required.
Maintains formal and informal contact with parents/legally responsible person and members of the multidisciplinary team periodically and as needed.
Prepares and submits required documentation for personal reimbursement of work related milege, use of PTO, timesheets, and any other required reports accurately and on a timely basis.
Ensures accuracy, completion and maintenance of service records and staff competency files.
Ensures all supplies for Tailored Plan Care Management Services are coordinated and ordered through the established procedures.
Creates needed templates, grids, graphs, etc. to operate and manage Tailored Care Management Services.
Ensures maintenance needs are identified and processed through established procedures.
Promotes safety of all staff and individuals in TCM Services.
Ensures the protection of Human Rights and reports any suspicion of violations immediately to supervisor.
Attends all Leadership Meetings and keeps staff updated and ensures any follow up as needed.
Creates training materials for staff and ensures implementation. Follows up as needed.
Prepares and monitors contracts. Works closely with supervisor and accounting in preparation, implementation and monitoring.
Analyzes TCM data for trends, appropriate outcome measures, leveling and tiering activities and complies with all quality metrics reporting requirements.
Assists with providing services linkages.
Ensures contracts for required clinical consultation services.
Does not carry a case-load, but assists Care Managers with Clinical Assessments and Plan Development and implementation as needed to cover staff outages or comply with required TCM timelines.
Able to utilize and train staff on needed IT systems, EHR systems, MCO Platforms and NC360 as necessary to meet all TCM requirements.
Ensures a workable on-call system to require with 24/7/365 coverage responsibilities.
Oversees caseload and work assignments to match care managers skills, meet individual needs, meet TCM time requirements and ensure cases are fairly evenly distributed among TCM staff.
Financial:
Monitors and reviews billing for accuracy and submits documentation to proper agency. Follows up as needed. Ensures minimum contact requirements for TCM billing are maintained.
Ensures invoices are prepared and forwarded to Accounts Payable. Follows up as needed.
Ensures proper documentation is forwarded to Reimbursement Officer for contract agencies.
Ensures that program operates within approved budget. Identifies problem areas and reports to supervisor.
Authorizes accounts payable up to a pre-approved amount.
Monitors and approves monthly petty cash reimbursement.
Ensures and monitors all funding sources for each individual and ensures that eligibility is current.
Participates in budget preparation and revisions.
Ensures authorizations are current and in place for all services to be billed. Follows up as needed with staff and accounting.
Educate staff regarding the budgetary process and their individual role toward financial stability of the program.
Monitors and provides feedback regarding acuity tiering of individuals in services.
Supervision:
Supervises staff in the day to day operation of TCM Services and ensures over all operation of the program unit.
Ensures staff training is provided in a comprehensive, timely and economical fashion.
Completes performance plan and annual performance appraisals for directly supervised staff using staff input.
Conducts regular staff meetings. Keeps supervisor updated and informed.
Ensures staff have the required competency level to provide services for individuals in the program. Follows up as needed.
Ensures staff prepare and submit documentation for timesheets, use of PTO, request for reimbursement of work related mileage and other required reports accurately and in a timely manner.
Ensures compliance with ComServ, Inc. personnel policies related to hiring, suspending, and separation of employment.
Ensures the development, implementation, and monitoring of supervision plans for identified staff; maintains documentation.
Ensures compliance with all CMS, DHHS, licensure and state as well as federal laws and regulations.
Regulatory:
Ensures compliance with all federal and state guidelines regarding licensure and regulatory standards, including ComSer, Inc., Policy and Procedures and accreditation bodies.
Ensures maintenance of all CMA agency requirements.
Maintains compliance with all Federal Wage/Hour laws. Follows up as needed.
Ensures that all grievances, complaints, and investigations are followed through accurately and in a timely manner.
Ensures protection of Human Rights and confidentiality in compliance with federal and state laws.
Has an extensive working knowledge and adheres to all ComServ, Inc. Policies and Procedures.
Ensures HIPAA is implemented and follows up as needed.
Works with Therap and MCO Platform to ensure appropriate HIPAA compliant role-based access to EHR and timely sharing of required health information to meet TCM requirements.
Documentation:
Oversees documentation of individuals services as required by the funding source.
Ensure that service records are monitored for all required qualitative and quantitative components.
Supervises and oversees documentation all pertinent information to include (but not limited to) incident reports, monthly status updates, TCM service notes, referrals and referral follow- ups admissions, and discharges, etc.
Collects graphs and percentages as required per service definition. Analyzes TCM data to meet all quality metric requirements.
Develops effective strategies for providing input and monitoring of teiring and acuity leveling,
Provides information on appropriate risk factors and social determinants of health for the IDD population.
Develops and monitors to ensure that documentation and billing processes are completed. Ensures minimum contact requirements and activities are completed for each TCM recipient based on acuity levels.
Ensures TCM Care Managers are documenting medication monitoring according to TCM requirements.
Clinical:
Facilitates and/or participates in Comprehensive Clinical Assessment Processes as needed. Ensures departmental resources are directed toward achieving required CA timelines.
Participates in multidisciplinary team meetings, ensuring provision of whole person care.
Supervises the clinical operation of the TCM program.
Ensures individuals receive TCM required monitoring activities inclusive of addressing all needs, medical monitoring, incorporating individual and family supports, and role based communications with the individuals team.
Ensures notes meet legal and regulatory specifications of services provided; ensures notes match the person centered plan; provides supervision for corrections as needed.
Participates in admission and discharge processes as needed.
Ensures that all restrictive interventions/human rights violations and any Level II and III incident reports are reviewed by the Human Rights Committee. Follows up as needed.
Ensures that individuals are informed of Human Rights at admission and annually thereafter until discharge.
Communicates and coordinates with outside agencies to ensure completion of PCP/ISP.
Ensures that the PCP/ISP is followed.
Ensures clinical documentation is completed accurately for all services provided in the program.
Ensures, implements and monitors programmatic recommendations in a timely fashion. Follows up as needed.
Provides clinical consultation on individual specific situations as needed and arranges for consultation with on-contract specialists as needed
Acts as liaison for families and community agencies and any other stakeholders.
Ensures and monitors relevant communication between TCM services and other programs, agencies and services as it relates to individuals served. Follows up as needed.
Other:
Attends all training required for the position. Attends any outside training and education as assigned and approved by your supervisor.
ComServ, Inc. pre-service and annual updates
Overview of all ComServ policies and procedures for Care Management and Tailored Plan Care Management Services
Training on NCCare 360 and on addressing unmet needs
Training on Therap IT modules
Training on MCO Care Management Platforms
Training on Conducting Tailored Plan Comprehensive Assessments
Training on Whole Person Integrated Care and development of Care Plans
Training on Facilitating Multidisciplinary Teams
Training on Managing Care Transitions
Training on Innovations Waiver requirements
Working with Clinical Consultants
Work flows and supervisory training
Ensuring effective clinical coverage on a 24/7/365 basis
Acts as a role model for other ComServ, Inc. staff and individuals receiving services.
Ensures and supports cultural competency in conducting responsibilities that is reflective of the community and individuals served in regard to culture, age, gender, sexual orientation, spiritual beliefs, socioeconomic status, and language.
Adheres to ComServ, Inc. mission, vision and philosophy.
Participates on committees as assigned by supervisor.
Employee in this position must be flexible with schedule and make changes as requested or required by position responsibilities.
Ensures that all ComServ, Inc. equipment or vehicle used in conducting the responsibilities of this position is used in a responsible manner and maintained properly.
Adheres to ComServ, Inc. Code of Conduct.
Adheres to ComServ, Inc. Code of Ethics.
Performs other duties as deemed appropriate by your supervisor.
Other Skills:
Adaptability
Remains effective despite changes in job
Moves through a variety of tasks requiring different approaches, knowledge and concerns
Moves from one job priority to another as required by internal and external demands
Collaboration/Team Work
Acknowledges the importance of others opinions and ideas; accepts that some people will never be completely convinced of one point of view
Works toward solutions
Judgment
Considers the pros and cons before making a decision
Considers organization and managements views
Thinks about and deals with potential problems that might be coming from a decision
Planning and Organizing
Documents important tasks or activities to achieve required results
Distinguishes between what is urgent and what is not in setting priorities
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to perform the physical life functions of walking, talking, reaching, stooping, and lifting, fingering, hearing and repetitive motions. Must be able to perform light work exerting up to 10 pounds of force occasionally. Must possess visual acuity to prepare and analyze data and figures, and to operate computers.
Minimum Education & Experience Requirements:

• A bachelors degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area and Five years of experience providing care management, case management, or care coordination to complex individuals with I/DD; OR
• A masters degree in a field related to health, psychology, sociology, social work (e.g., LCSW), nursing, or another relevant human services area, 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

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*Special Knowledge, Skills & Abilities: *

• Ability to read, write, follow instructions, read directions, perform basic math.
• Shall be willing and able to use various and creative means of communication.
• Should exhibit characteristics such as patience, kindness, and an eagerness to help.
• Must be flexible, and display a willingness to adapt to ever-changing environments

due to the individual needs of the population served.

• Potential employees must have a valid North Carolina drivers license and possess a

safe driving record as deemed acceptable by the companys insurance provider.

• Should be able to use good judgment.
• Must be able to respond to emergencies, collaborate and work as part of a team.
• Must exhibit a positive attitude.

Adaptability

• Remains effective despite changes in job
• Moves through a variety of tasks requiring different approaches, knowledge and concerns
• Moves from one job priority to another as required by internal and external demands

**
*Collaboration/Team Work*

• Acknowledges the importance of others opinions and ideas; accepts that some people will never be completely convinced of one point of view
• Works toward solutions

**
*Judgment*

• Considers the pros and cons before making a decision
• Considers organization and managements views
• Thinks about and deals with potential problems that might be coming from a decision

**
*Planning and Organizing*

• Documents important tasks or activities to achieve required results
• Distinguishes between what is urgent and what is not in setting priorities.

Location: 785 Hwy 70 SW Suite 200, Hickory, NC 28602

Location: 785 Hwy 70 SW Suite 200, Hickory, NC 28602

Job Type: Full-time

Schedule:

• 8 hour shift
• Monday to Friday
• On call

Application Question(s):

• What are your salary expectations for this role?
• What about this role excites you and motivated you to apply?

Education:

• Master's (Required)

Experience:

• Care plans: 1 year (Preferred)

Work Location: One location