Tailored Care Management Program Manager
Company Overview
Comprehensive Interventions, Inc. is a dedicated behavioral and mental healthcare provider serving diverse populations in. With over 20 years of experience, we are committed to delivering comprehensive, integrated health services that address emotional, mental health, and substance use challenges. Our organization values diversity, innovation, and community collaboration to eliminate barriers to care and promote holistic well-being.
POSITION SUMMARY
Comprehensive Interventions, Inc. is seeking an experienced and highly organized Tailored Care Management Program Manager to provide leadership and oversight for its Tailored Care Management program.
The Program Manager will oversee the daily operations of the program and supervise care managers and care manager extenders serving children, adolescents, and adults with serious mental illness, serious emotional disturbance, severe substance use disorders, intellectual or developmental disabilities, traumatic brain injury, long-term services and supports needs, and co-occurring conditions.
The successful candidate will have a strong understanding of whole-person care management, state requirements, person-centered planning, behavioral health, physical healthcare coordination, I/DD and TBI services, community resources, quality assurance, staff supervision, and clinical documentation.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Program Leadership and Compliance
- Manage the daily operations of the Tailored Care Management program in accordance with contractual, accreditation, and agency requirements.
- Maintain current knowledge of the Tailored Care Management Provider Manual, service requirements, technical guidance, training updates, and payer expectations.
- Develop, implement, and monitor program policies, procedures, workflows, and performance standards.
- Ensure the program maintains adequate staffing, appropriate coverage, and the capacity to meet members’ needs.
- Participate in audits, monitoring reviews, quality-improvement activities, corrective-action plans, and readiness activities.
- Monitor program performance, service delivery, member engagement, documentation, billing readiness, and outcome measures.
- Prepare and submit required internal and external reports accurately and on time.
- Collaborate with executive leadership, compliance, billing, intake, medical records, clinical programs, and community partners.
- Maintain strong working relationships with Tailored Plans/LME/MCOs, healthcare providers, behavioral health providers, I/DD and TBI providers, hospitals, schools, DSS agencies, pharmacies, and community organizations.
Staff Supervision
- Provide structured supervision, consultation, coaching, and performance management to care managers and care manager extenders.
- Arrange appropriate coverage for employee vacations, sick leave, vacancies, and other staffing interruptions.
- Review staff productivity, member contact requirements, outreach efforts, documentation timeliness, and quality of services.
- Provide guidance to care managers regarding complex cases, member needs, service barriers, transitions of care, crisis concerns, and coordination with multidisciplinary care teams.
- Directly oversee or ensure appropriate direction of care manager extenders and confirm that extenders perform only authorized functions.
- Conduct regular individual and team supervision and maintain required supervision documentation.
Assessment and Care-Planning Oversight
- Monitor the timely completion and quality of care management comprehensive assessments, reassessments, Care Plans, Individual Support Plans, crisis plans, and related documentation.
- Ensure assessments address physical health, behavioral health, I/DD, TBI, pharmacy, long-term services and supports, functional needs, and unmet health-related resource needs.
- Ensure Care Plans and ISPs are individualized, person-centered, strengths-based, measurable, and developed collaboratively with members, guardians, families, and care-team participants.
- Review Care Plans and ISPs for quality, completeness, clinical appropriateness, member participation, required signatures, and timely updates.
- Monitor triggering events that may require reassessment or revision of the Care Plan or ISP.
- Ensure urgent needs are identified and addressed
- Confirm that assessment findings and care-planning information are shared with authorized care-team members within required timeframes.
Member Engagement and Service Coordination
- Ensure staff conduct timely, persistent, and strategic outreach to members and document all outreach attempts.
- Monitor qualifying member-facing contacts and ensure contact frequency and methods are based on each member’s preferences, risks, and level of need.
- Promote frequent in-person engagement in members’ homes, provider settings, and community locations when clinically appropriate.
- Ensure members receive comprehensive, integrated care management addressing behavioral health, physical health, pharmacy, I/DD, TBI, LTSS, and social needs.
- Oversee transitional care following hospitalizations, emergency department visits, facility discharges, incarceration, foster-care transitions, or changes in living arrangements.
- Ensure effective coordination of appointments, referrals, medications, benefits, transportation, housing, food resources, education, employment, and other community supports.
- Support the development and operation of multidisciplinary care teams.
- Ensure appropriate coordination during urgent and emergent situations, including behavioral health crises.
- Support the agency’s ability to arrange care-management coverage, consultation, referral, and coordination 24 hours per day, seven days per week.
Quality Assurance and Documentation
- Conduct routine record reviews to ensure services are timely, complete, accurate, person-centered, and compliant.
- Monitor consent, assessment, reassessment, care-planning, follow-up, referral, transition, and contact documentation.
- Ensure protected health information is exchanged through secure, authorized systems in compliance with HIPAA and applicable state and federal requirements.
- Monitor the accuracy of data entered into the electronic health record, Tailored Plan portals, NCCARE360, NC HealthConnex, and other required systems.
- Work with billing and medical records personnel to resolve documentation or claim-readiness concerns.
- Analyze program data and develop improvement plans addressing engagement, quality, timeliness, productivity, outcomes, and compliance.
- Report significant clinical, operational, safety, or compliance concerns to agency leadership.
MINIMUM QUALIFICATIONS
- A current license, provisional license, certificate, registration, or permit issued by the governing board regulating a human-service profession, such as LCSW, LCSWA, LCMHC, LCMHCA, LMFT, LMFTA, LCAS, LCASA, LPA, or another qualifying credential; or
- At least two years of experience providing care management, case management, or care coordination to the population being served.
Additional Requirements
- Previous supervisory, management, or program-leadership experience.
- Demonstrated experience with care management assessments, person-centered Care Plans or ISPs, referrals, service coordination, monitoring, and follow-up.
- Working knowledge of NC Medicaid, Tailored Plans/LME/MCOs, behavioral health services, I/DD services, TBI services, LTSS, HCBS, and community resources.
- Ability to interpret service definitions, provider manuals, contracts, policies, and regulatory guidance.
- Strong leadership, critical-thinking, problem-solving, organizational, and communication skills.
- Ability to manage multiple priorities, deadlines, audits, and program requirements.
- Proficiency with electronic health records, Microsoft Office, virtual meeting platforms, and web-based payer systems.
- Ability to complete clear, accurate, and timely documentation and reports.
- Ability to successfully complete all required criminal-background, healthcare-exclusion, reference, and credentialing checks.
- Ability to complete all required Tailored Care Management training and ongoing annual refresher training.
KNOWLEDGE, SKILLS, AND ABILITIES
- Commitment to person-centered, family-driven, culturally responsive, trauma-informed, and recovery-oriented care.
- Ability to lead, support, and hold staff accountable for performance and compliance.
- Ability to evaluate complex member situations and provide effective guidance.
- Ability to build collaborative relationships across healthcare and community systems.
- Ability to maintain confidentiality and exercise sound professional judgment.
- Ability to recognize and respond appropriately to urgent, emergent, and crisis situations.
- Ability to analyze program data and translate findings into corrective or quality-improvement actions.
WHAT WE OFFER
- Competitive salary
- Health, dental, and vision insurance
- Paid time off and paid holidays
- Professional development and required training
- Supportive leadership team
- Opportunities for professional growth
- Meaningful work that improves outcomes for individuals and families across North Carolina
ABOUT COMPREHENSIVE INTERVENTIONS, INC.
Comprehensive Interventions, Inc. is a CARF-accredited, minority-owned behavioral healthcare organization that has served North Carolina communities since 2003. We are committed to providing respectful, person-centered, high-quality services guided by our values of teamwork, friendliness, respect, integrity, fairness, and learning.
Pay: $60,000.00 - $65,000.00 per year
Benefits:
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Vision insurance
Work Location: Remote
