Tailored Care management is provider-based, performed at the site of care, in the home, or in the community, through face-to-face interaction between beneficiaries, providers, and care managers. Provider-based care management will promote whole-person care, foster high-functioning integrated care teams, and drive toward better health outcomes. The model will require provider organizations to coordinate physical health, behavioral health, and IDD /traumatic brain injury (TBI) services. Since only some duties associated with this position may be described herein, employees may be required to perform duties not specifically spelled out in the job description, but which may be reasonably considered incidental in the performing of their duties.

Through Tailored CM, Behavioral Health I/DD Tailored Plan beneficiaries will have a single designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all of their needs, spanning: physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS) and unmet health-related resource needs. Tailored Care Management will:

• The primary responsibilities of the Behavioral Health Care Manager are to promote the whole person, and integrated care by planning, coordinating, tracking, closing gaps in care, and monitoring care to individuals to achieve the key goals of the behavioral health tailored plans.

• Be available throughout a beneficiary’s enrollment in a Behavioral Health I/DD Tailored Plan.

Requirements

Care management staff. The organization must be able to ensure that all care managers, supervising care managers, and care manager extenders providing Tailored Care Management meet the following minimum qualification requirements.

Care managers serving all members must have the following minimum qualifications:

• Master’s degree in a human service field with 2 years experience working directly with individuals with behavioral health conditions (if serving members with behavioral health needs) or with an I/DD or a TBI (if serving members with DD /TBI).
• Provisional/full licensure required (LCSW/LCMHC/LCAS/LMFT)  
• Care managers serving members with LTSS need two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience, in addition to the requirements cited above.
• Valid driver’s license.
• Experience in Microsoft Office products 365 (Word PowerPoint, Outlook, and Excel).