LOCATION: Remote - must live in North Carolina or within 40 miles from the NC border, preferably near Vaya's catchment area. Vaya operates within the hours of 8:30am-5:00pm EST.GENERAL STATEMENT OF JOBDirectly supervises and oversees the performanceof Registered Nurse (RN) and Occupational Therapist (OT) supervisors, as well as the performance for the overall RN and OT team. Oversees the team performing nursing and occupational therapy assessments and supports for adult members that are medically fragile or have significant chronic health conditions, have a mental health, substance use or co-occurring disorder who are transitioning out of Adult Care Homes (ACH), State Psychiatric Hospitals (SPHs) or those being diverted from institutional settings. Individuals served may also have a co-occurring intellectual or developmental disability. This position will work collaboratively with other Vaya staff, behavioral health providers, Primary Care Physicians, specialty care providers and other community partners and stakeholders to support members in their home communities. Work is performed under the supervision of the Transition and Housing Director.The role can involve a range of scenarios which require a wide array of potential responses including micro and macro level interventions. The manager will create and evaluate workflows to ensure that staff have clear guidance for their roles and responsibilities. The manager will evaluate process and implement process improvement where needed. Development and oversight of processes and workflows may include; but are not limited to assessment, care monitoring, care planning, patient and family education, medication reconciliation, researching, linking, reviewing documentation, phone communication, attendance at treatment team meetings, and consultation. The manager on this team will ensure that the RNs and OTs have regular visits with patients in ACHs and with patients living in the community, assess health literacy, provide patient and family education, facilitate clinical rounds, partner with ACTT RN, EMS, or other medical providers on routine patient home visits, be a consultative resource for other Vaya team members.ESSENTIAL JOB FUNCTIONSSupervision and Program Implementation and Planning:
- Provide oversight to supervisors and teams to ensure effective performance
- Develop, organize and delegate workflows and tasks to team
- Monitor performance and staff adherence to contract requirements and to the Code of Ethics and Conduct and policies
- Provide guidance for and develop leadership skills in supervisors
- Use technology to assist in organizing and developing workflows
- Develop and implement training plan for staff
- Coordinate workflow for participant education, related to physical and behavioral health conditions
Contract Performance and Data Reporting:
- Use data, assessment, chart review and supervision to measure results of interventions and treatment, including reduction in high-risk events
- Produce monthly and quarterly reports on program components
Safety Oversight:
- Ensure service needs are addressed and coordinated by staff through the collection, entry, maintenance, analysis and reporting of data associated with psychiatric and medical treatment
- Appropriately escalate high risk scenarios to appropriate leadership. High risk can involve Health & Safety of an individual served, staff or organizational risk
- Ensure that services for the individual are coordinated across the Vaya Health system and with other healthcare and social determinant systems
- Understand the role of and collaborate with Transition and Housing teams, Acute Response team, Hospital Emergency Department, or Inpatient Discharge planning teams, participate in developing transition plans, educating staff and members regarding network services and supports with consideration of medical necessity, funding eligibility and appropriateness of recommendations relative to person centered, recovery principles and known best/appropriate practice
Collaboration:
- Develop relationships with community stakeholders to streamline service provision to members and efficient use of professional resources
- Partner with primary care providers, specialty care providers, behavioral health providers, home health care and personal care providers, as well as other stakeholders
- Proactively work with team to identify gaps in services and intervenes to ensure that the individuals and specialty populations receive appropriate care
- Provide support to team addressing barriers to care for members through convening key providers and others to address needs of the individual or populations at the individual or system level
Documentation:
- Timely and complete documentation regarding member specific interactions is required
Staff Education:
- Vaya staff resource and provide training related to medical and MHDDSU
KNOWLEDGE, SKILL & ABILITIES
- A high degree of professionalism and ability to navigate complex communication across teams/stakeholders with tact and diplomacy
- A high level of skill using technology to organize workflows, data outcomes and ability to learn new technology, as programs and technology platforms change
- Ability to be a liaison with community hospitals and work with ACTT RNs, EMS, and other medical teams on development of partnership for non-emergent patient care and patient education
- Timely and complete documentation regarding member specific interactions is required
- Effective care coordination requires a detailed knowledge of the state plan, service availability, service definitions, network providers, community resources, mainstream and alternative funding sources
- Requires clinical knowledge, awareness of community resources, strong communication skills, effective problem-solving abilities, and an ability to apply these skill sets across diverse and complex situations
QUALIFICATIONS & EDUCATION REQUIREMENTS
- Bachelor's Degree in Nursing and at least 5 years of experience in the medical field required. Prior supervisory or managerial experience is preferred.
Licensure/Certification Required:
- Must be currently licensed to practice as a Registered Nurse in North Carolina.
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: The person in 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 FilledAPPLY: Vaya Health accepts online applications in our Career Center, please visit Vaya Health is an equal opportunity employer.