Complex Care Consultant (OT) (Full-time Hybrid, North Carolina Based) (Healthcare)

The Complex Care Consultant shall provide physical health and functional assessments and transition planning assistance primarily for TCL members transitioning from Adult Care Homes (ACHs), and to the extent capacity allows, to TCL members transitioning from other settings, with complex medical and/or functional conditions that significantly impede the transition of the member into the community (severity is determined by the PIHP screening process). 

This position will require extensive travel and may include visits with members in Adult Care Homes and member living in the community. One day a week is required onsite at the Home office in Morrisville, NC.

Responsibilities & Duties

Provide Care Team Support

• Support members transitioning from institutional care settings to community-based care
• Provide subject matter expertise, within scope of license, regarding member's physical health to support the development and delivery of a whole person approach to Care Management 
• Work collaboratively with other Alliance staff, behavioral health providers, primary care physicians, specialty care providers and other community partners and stakeholders to support members in their home communities

Complete Assessments and Planning

• Utilize person-centered planning, motivational interviewing, and assessments to gather information 
• Perform individual assessments/screenings for members that are medically fragile or have significant health conditions, have a mental health condition, substance use condition, or co-occurring intellectual or developmental disability
• In the Transition and Housing setting, staff will also assess and record member's activities and progress
• Provide education and supports to members and/or legal guardians regarding self-care strategies, their rights and responsibilities, available treatment options, provider network availability and payor requirements that may impact service access or maintenance 
• Educate team members about impact of member's health conditions on service engagement, clinical outcomes, and prognosis for change
• Actively collaborate with member and care team members to ensure care plan accurately reflects the individual's clinical needs and desired life goals 
• Update Assessments and plans of care as needed
• Provide education about advanced directives, preferred natural support and physical health contacts whom the member identifies, and preferred crisis facilities
• Provide medication reconciliation and education 
• Develop and update plans of care based off the needs identified in the assessments and complete the interventions identified as needed
• Review member's medical history and identify specific goals and types of activities that will be used to help member work to help work towards those specific goals
• Proactively works with the member's multidisciplinary care team to identify gaps in services and intervenes to ensure that the member is receiving the appropriate level of care
• Complex Care Consultant team may evaluate a member's home and based on member's needs, may identify needed improvements and/or special durable medical equipment and instruct member's on how to use this equipment

Monitoring/Coordination

• The Complex Care Consultant team will continue to be involved with the member for 90 days after the move to provide additional support and recommendations that may be needed to reduce crisis service/inpatient utilization and retain housing
• Appropriately escalate high risk/high visibility and/or complex barriers/needs members who may have difficulty transitioning out of the facility in a timely manner to supervisors. High risk can involve Health and Safety of a member, staff, or organizational risk
• Review cases with clinical complexity with direct supervisor, peer clinical review cohort, and utilization management care managers and medical management leadership as needed
• Obtain information releases that will improve care management activities on behalf of the member
• Reports care quality concerns to Quality Management as needed 

Documentation

• Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements 
• Follow administrative procedures and effectively manages caseload

Data

• Review, validate and interpret risk stratification data and population health groups and recommend changes or adjustments to care management approach as needed
• Utilize data to analyze needs of the members we serve, guide staff training development, identify resource needs and consistency of workflow implementation across disciplines

Travel

• Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance sponsored events, etc is required for member facing visits in the ACH and/or other community-based settings
• Travel to meet with members, providers, stakeholders, attend court hearings etc. is required

Minimum Requirements

Education & Experience

Graduation from an accredited Occupational Therapy program, completion of the National Board for Certification in Occupational Therapy (NBCOT) exam with a passing score, possession of an active license from the North Carolina Board of Occupational Therapy (NCBOT), and at least two (2) years of full-time, post graduate degree, experience.

Or

Graduation from a school of nursing and two (2) years of full-time nursing experience with the population served and active NC or Compact Registered Nurse License

Preferred Experience

Home & Community based service

Required License

Active, valid North Carolina Board of Occupational Therapy (NCBOT) license or active NC or Compact Registered Nurse License

Knowledge, Skills, & Abilities

• Demonstrated knowledge of the assessment and treatment of mental health, substance abuse, intellectual and developmental disabilities,
• Knowledge of legal, waiver, accreditation standards and program practices/requirements.
• Knowledge of the Alliance Health service benefit plans and network providers.
• Person Centered Thinking/planning
• The employee must be detail oriented,
• Ability to independently organize multiple tasks, priorities, and to effectively manage an assigned caseload under pressure of deadlines.
• Exceptional interpersonal skills, highly effective communication ability,
• Ability to make prompt independent decisions based upon relevant facts and established processes.
• Problem solving, negotiation and conflict resolution skills
• Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required.

Salary Range

$68,227 -$88,695/Annually 

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, Short and Long- and Short-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

Education

Preferred

• Associates or better in Nursing
• Masters or better in Occupational Therapy

Licenses & Certifications

Required

• Occupational Therapy-NC
• Registered Nurse

Skills

Required

• Person Centered Thinking/Planning
• Communication
• Interpersonal Skills
• Microsoft Office
• Multitasking

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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