Case Manager

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Case Manager Full Time Care Coordination Middlebury, VT, US Summary of position Case Management position coordinates the ’s application, referral, support planning, and monitoring processes in compliance with all applicable policies and procedures, including but not limited to all current and thereafter amended federal, state, and local standards, guidelines, and regulations. Hybrid position with required travel throughout Addison County in Vermont. Must reside within 60 miles/minutes of Addison County, VT. Essential Functions The Case Manager responsibilities include but is not limited to the following: Comply with all rules, regulations, policies and procedures of the agency and Vermont’s HCBS Eligibility and Enrollment Processes. Have experience with the Department’s state statutes, state rules, definitions, program requirements, program specific services, variances and exceptions. Engaging in assessment and planning activities for the individual’s services which includes but it not limited to: Assist and support the individual to understand the goals and activities of the individual-centered planning process, including assessment. Facilitate and schedule participation in individual-centered planning and assessment as needed. Complete Needs Assessment Annual Review Protocol once a year with the individual and their team. Assist the individual in discovery and exploration discussions, identifying preferences, strengths, goals and dreams, and needs in preparation for individual-centered planning process. Facilitate the completion of the DS Budget and Service Planning Context Document. Facilitate the completion of any additional assessments and gathering of documentation as needed, and ensure this information is available for the individual-centered planning process. Assist the individual to invite people of their choice (excluding legally prohibited individuals) to participate in the Individual Services Agreement (ISA) planning meetings to occur at times and in locations selected by and convenient for the individual. Work with the individual to develop agenda(s) and follow up notes for individual-centered planning meetings and ensure this information is distributed to members of the support team as approved by the individual. Support the individual to lead, and provide assistance as needed, throughout the individual- centered planning process. Assist the individual and their support team in identifying any needed modifications to the rights and freedoms afforded by the federal Medicaid HCBS requirements based on a documented health and safety need, and ensure that any such modifications are appropriately agreed upon by the individual and their guardian (if they have one) and documented in the ISA/BIP, including a plan for data collection and review of the modification. Review and updating of the individual-centered service ISA and related documents (including assessments), at minimum annually, with the individual. Provide the individual with information on self-direction opportunities, including the potential benefits, responsibilities and risks associated with self-directing services, during the planning process and upon request. Provide information to the individual on complaints, grievance and appeals rights, explain what these processes entail, and offer referrals to third-party assisters (such as Vermont Legal Aid and Disability Rights Vermont) when needed or upon request. Provide accessible information in the preferred method and language of the individual about individual rights and responsibilities annually and upon request. Coordinate meetings for the individual with other people receiving services from the providers under consideration who would be willing to give consent to share their experiences about those providers, as requested. Communicate the service authorization status to service plan team members, as appropriate. Make referrals to providers and provide follow‑up assistance. Identifying and linking to supports activities including but not limited to: Link the service and support needs of the individual with resources in the community which includes researching existing and identifying new resources in the community that may help individuals achieve the goals of their plans. Inform individuals about the use of unpaid, informal, generic, and specialized home and community‑based services and supports that are necessary to address the identified needs of the individual and to achieve the outcomes specified in the ISA/BIP. Assist the individual in identifying and choosing service provider agencies and self‑direction options to met their needs and achieve the outcomes specified in the individual‑ centered service plan. When the regional Designated Agency (DA/)/Specialized Service Agency (SSA/)/Brain Injury Program (BIP) provider is unable to provide necessary services directly, collaborate with DA/SSA/BIP provider to refer to another DA/SSA/BIP provider or identify subcontracted service options and authorize the use of specific subcontractors and subcontracted services in compliance with relevant guidelines and policies. Coordinating and Monitoring activities including but not limited to: Coordinate individual‑centered service plan implementation with the individual and their support team (including family members, guardians when applicable, providers, resources and programs) to ensure all areas of the individual’s needs, preferences and outcomes as specified in the ISA/BIP are addressed. Support collaboration with people, organizations and resources that are important to the individual and necessary for the achievement of their goals and outcomes. Ensure that necessary documents and records are available and distributed to the support team, including the individual and their guardian (if they have one), family members, providers and natural support as the individual chooses or as required. As needed, coordinate and facilitate meetings between the individual and their DA/SSA/BIP provider, subcontractors, and/or self‑directed employees to discuss the delivery of services. Assist in problem‑solving and the resolution of barriers to receipt of services and supports, or barriers to accomplishments of outcomes specified in the ISA /BIP. Assist with the transition to the self‑direction service delivery model if the is interested and ensure continuity of services during transition. Ensure that individuals are receiving the support they need as specified in the ISA/ BIP, when they need it, in order to see measurable improvements in their lives. Monitor the ISSA implementation, satisfaction, and health and well‑being through visits with the individual and review of documentation, and through engagement with their guardian (if they have one), family members as applicable, and their service providers. Review, assess and respond to emergency situations and incidents and assure that actions taken are appropriate and timely to protect the health and welfare of individuals. Validate that services provided are consistent with the ISA/ BIP, and the needs and desired outcomes. Review individual progress on outcomes and initiate individual‑centered team discussions or meetings when services are not achieving desired outcomes. Monitor the individual’s satisfaction with services, as well as the satisfaction of family members and guardians as applicable. Arrange for changes in services as necessary to address the needs or preferences of the individual and modify the ISA /BIP accordingly. Advocate for continuity of services, system flexibility and community integration, proper utilization of resources, accessibility, and rights. Participate in activities related to quality monitoring and reporting as required by the State. Self‑Direction Process: The Case Manager must provide information to the individual about the ability to self‑direct their services and supports. Complete Employer of Record Assessment Tool to determine individual and/or identified surrogate’s capacity to perform employer responsibilities and level of support to be successful. If determined appropriate for the individual or surrogate to self‑direct some or all direct services, the Case Manager will provide information related to support brokering services to determine if inclusion in the ISA and support the individual in finding a support broker that will meet #J-18808-Ljbffr The Columbus Organization, LLC