This position is responsible for coordinating Personal Care Service (PCS) for Tailored Plan members. This role is critical to support a member’s success in the least restrictive community setting through facilitation of timely assessments, coordination of services with provider agencies after assessment, and care manager collaboration.
This is a full-time remote opportunity. There is no expectation of being in the office routinely, however, the selected candidate must be available to report onsite for business meetings as needed. This position is required to reside in North Carolina or within 40 miles of the North Carolina border.
Responsibilities & Duties
Referral & Assessment Coordination
- Monitor for incoming referrals
- Review all referrals to ensure eligibility aligns with workflows and procedures guided by the PCS Clinical Coverage Policy
- Based on review, prioritize referral status and facilitate assignment and follow-up by PCS RN in accordance with prioritization and workflow timelines
- Provider outreach and engagement to obtain additional needed information to process assessment referral. Escalate barriers to engaging providers to supervisor
- Track and coordinate assignment of annual reassessments
Care Coordination
- Engage with member’s preferred servicing PCS agency to confirm agency acceptance of member to services
- Member outreach and engagement to select an alternate agency, ad hoc when preferred agency unable to accept member to services
- Data enter authorization request in the CM platform
- Collaboration with care management to ensure provider follow-up requirements are met by the member prior to annual assessment
Administrative Support
- Coordinate mailings and other modes of communication related to PCS workflows and processes
- Member outreach and engagement to schedule RN assessments
- Coordination of RN assessor calendars and schedules
- Maintain documentation and referral tracking in the appropriate software system
- Monitor and maintain the PCS mailbox
- Coordinate and facilitate meetings with internal and external stakeholders as needed
- Facilitate follow-up and answers to questions from internal and external stakeholders regarding the PCS Assessment process
Professional Accountability
- Identify inefficiencies, barriers, or risk with PCS care coordination processes and offer recommendations for process improvement
- Adhere to policies, procedures, desk references, and workflows; to include meeting timelines and performance expectations
- Support leadership to review, revise, and maintain desk references and workflows
- Compliance with documentation standards within the CM Platform and other applicable software systems
- Maintain member privacy and confidentiality per policy and training
Minimum Requirements
Education & Experience
Required:
Master’s degree in a human service field with one (1) year post-graduate degree accumulated experience with individuals experiencing complex behavioral health, TBI, and/or I/DD with
OR
Bachelor’s degree in a human service or other related field with two (2) years post-graduate degree accumulated experience with individuals experiencing complex behavioral health, TBI, and/or I/DD
OR
Bachelor’s degree in a non-human service or other related field with four (4) years post-graduate degree accumulated experience with individuals experiencing complex behavioral health, TBI, and/or I/DD
At least one (1) year of experience in a healthcare setting with an integrated whole person care model (inclusive of both physical and behavioral health).
Preferred:
Experience with administrative support or secretarial roles
Knowledge, Skills, & Abilities
- Demonstrated application of excel skills
- Demonstrated application Outlook and Teams skills
- Applied skills with computer equipment and web-based software to conduct work and documentation
- Interpersonal and communication skills
- Ability to interact with healthcare professionals, patients, their families and other supports.
- Ability to communicate effectively to individuals and groups through spoken, written and electronic media.
- Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.
- Ability to work independently without a high degree of supervision.
- Demonstrated application of Word and PowerPoint skills
Salary Range
$25.00-$30.29/Hourly
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
