LOCATION: Remote - must live in or near Vaya's Western North Carolina counties: Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Swain, Transylvania, Watauga, Wilkes, or Yancey. Incumbent must reside in North Carolina or within 40 miles of the NC border. This position requires travel in the community and visits to our members .

GENERAL STATEMENT OF JOB

The primary purpose of this position is to serve individuals with serious mental illness (SMI) who are being released from a DAC (Department of Adult Corrections) Facility and will be prioritized for re-entry coordination by both DAC and the applicable LME/MCO. This position will ensure communication between all parties, including DAC and related divisions (health services, re-entry, community supervision) and community behavioral and physical health providers. The DAC Re-entry Coordinator will ensure referrals are made to all necessary services including medication management, housing support, other social determinants of health needs, behavioral and physical healthcare, and benefits coordination. Referrals will be made by DAC directly to the DAC Re-entry Coordinator approximately 90 days prior to release from incarceration.

This position will allow Local Management Entities/Managed Care Organizations (LME/MCOs) to interact with individuals with severe mental illness (SMI) who are within 90-days of releasing from a DAC (Division of Adult Corrections) Facility earlier on in the discharge planning process in an effort to better support positive outcomes upon their release from prison. This position will be responsible for providing case management to individuals referred in the process. The DAC re-entry coordinator will follow an individual indefinitely or until they qualify for tailored care management or other service providing a TCM equivalent, such as Assertive Community Treatment. The initial time period for this service will be ninety (90) days with the option to continue until needs are met as noted above.

This position will promote an efficient, clinically sound, and person-centered approach to supporting individuals through this process. Contact with community stakeholders is significant and the re-entry coordinator is responsible for ensuring a high level of quality in customer service, including strong collaborative relationships with providers and key stakeholders (e.g. DAC, Hospitals, DSS, ACHs, behavioral health and physical health providers, internal departments, and natural supports).

This is a mobile position with work done in a variety of locations. The re-entry coordinator spends a considerable amount of time in the field and completes required documentation/paperwork at an office location or in the employee's home (as applicable).

ESSENTIAL JOB FUNCTIONS

Managed Care Treatment Planning and Care Coordination:

• Possess knowledge of the needs of individuals with a mental illness, and substance use/addiction disorders and effectively work with all individuals with respect on a level that they can understand and relate to
• Ensures all State mandated tasks related to Dispositions and discharge are completed within benchmark timeframes
• Ensures timely and thorough documentation of all efforts, both individual-specific and programmatically, as requested by Supervisor
• Coordinates with key providers and others in a collaborative approach to address needs of the individual and ensure appropriate treatment planning and evaluation
• Promotes person centered practices, including use of person-centered language and person-centered tools in planning
• Identifies gaps in services and intervenes to ensure that the individual receives appropriate care and discharge planning.
• Focuses on achieving positive outcomes for individuals, regardless of disposition status, including reduction in high-risk events and inappropriate service utilization
• Ensures that services for the individual are coordinated across the Vaya Health system and with other systems, including primary care. Refers to other specialists for timely assessment as clinically indicated
• Provides support and direction for the individual and his/her treatment team to ensure quality service and community integration
• Educates others about various housing options/resources and how to access them

Collaboration:

• Partners with individuals/families, providers and community stakeholders, as applicable, to create solutions to issues/concerns, barriers to progress, etc.
• Works in partnership with other Vaya Health departments to address identified needs and opportunities to improve member outcomes
• Work is performed with considerable independence, with most work performed in the community and away from the office. Employee is familiar with values and goals of Care Coordination, Vaya Health and minimal daily instruction is required. Formal supervision is scheduled monthly on an ongoing basis and informal supervision occurs as needed.

This is a mobile based position which primarily occurs during normal business hours. Employee is required to have and maintain high speed internet access (with a minimum download speed of 10Mb/s) in home residence as a condition of employment. The expense for installation and monthly maintenance of this internet access will be the responsibility of the employee. Driving is an essential function of the position. Travel within the community is required and after-hours meeting attendance should be expected upon occasion. Vaya Health reserves the right to call upon this employee during non-business hours as needed to meet the demands of the position.

KNOWLEDGE, SKILL & ABILITIES

• Ability to multitask and prioritize to manage multiple projects on tight timelines
• Ability to take ownership of projects from planning through execution
• Strong attention to detail and superior organizational skills
• Ability to understand the strategic direction and goals of the department and support appropriate processes to facilitate achievement of business objectives
• Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change
• Well-developed capabilities in problem solving and crafting efficient processes
• A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure
• An ability to initiate and build relationships with people in an open, friendly, and accepting manner
• An innate drive to innovate and optimize the use of available resources
• An ability to be a responsible self-starter
• Proficiency with Microsoft Office proficiency, to included Excel, data analysis, and secondary research
• Knowledge of and experience with managing an operations system
• High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance
• Exceptional interpersonal skills and highly effective communication ability in both written and oral form
• Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers
• Skilled at shifting between macro and micro level planning, maintaining both the big picture and seeing that the details are covered
• Considerable knowledge of the MH/SU/DD service array provided through the network of providers with additional knowledge in Medicaid B and C waivers, and NC DMA Clinical Coverage policies is essential
• Must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish
• Ability to change the focus of activities, when needed, to meet changing priorities
• Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required.
• Excellent written and verbal communication skills.
• Schedule Integrity combined with commitment to adhere to established deadlines.

QUALIFICATIONS & EDUCATION REQUIREMENTS

Master's degree in Psychology, Social Work, Counseling, or similar field and at least two years of progressive experience providing similar services to the populations served (MH/SU/IDD).

Licensure/Certification Required:

Must be fully or provisionally licensed mental health clinician. Master's-level fully Licensed Clinical Social Worker (LCSW), fully Licensed Clinical Mental Health Counselor (LCMHC), fully Licensed Psychological Associate (LPA), or fully Licensed Marriage and Family Therapist (LMFT).

Preferred Work Experience:

• Experience with DAC populations is preferred.

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: This position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled.

APPLY: Vaya Health accepts online applications in our Career Center, please visit

Vaya Health is an equal opportunity employer.