Care Manager I-Non-Waiver (Full Time, Hybrid, Harnett County, North Carolina Based)

Overview The Care Manager I-Non-Waiver ensures that individuals and families with special health care needs receive integrated whole-person care management, coordinating across physical health, behavioral health, pharmacy and unmet health-related resource needs to maximize outcomes and reduce unnecessary use of hospitals and emergency services. The role focuses on a specified population of members utilizing health care services, attending to all member health needs and referrals, and collaborating with community systems to support the identified population. The position is a full-time hybrid opportunity. While routine onsite attendance is not required, the selected candidate must be available to report onsite at the Alliance Office in Morrisville, North Carolina for business meetings and is expected to travel weekly throughout the Harnett County area to serve Alliance members as needed. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments or Care Needs Screening at enrollment, yearly, or when changes in condition occur. Develop Plans of Care derived from the completed assessments. Demonstrate commitment to whole person/integrated care. Assign interventions/plans of care to applicable Alliance Care Management team members for monitoring and/or service engagement activities. Submit referrals to the Transition Support Team when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity. Assign Plan of Care activities to Transition Support Team if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals or legally responsible persons in choosing service providers, ensuring objectivity in the process. Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification. Utilize person centered planning, motivational interviewing, and historical review of assessments in Jiva to gather information and identify supports needed for the individual. Assist in collecting data to identify and address barriers and determine the effectiveness of care management in reducing lengths of stay and use of emergency services. Actively collaborate with members, care team, service providers, and identified supports to ensure development of a plan that accurately reflects the individual’s needs and desired life goals, including collaborating with residential placement search in conjunction with internal team members or external stakeholders as needed. Submit required documentation to UM to ensure timely delivery of services and troubleshoot until authorization is obtained; notify a member’s care team and providers of successful authorization (for residential or waiver related services). Provide Support and Monitoring to Members Schedule initial contact with member for purpose of assessment and engagement. Verify accuracy of demographic information with member; update inaccurate information from the Global Eligibility File following documented protocols. Schedule face-to-face, virtual, and telephonic meetings with member or guardian to provide education about the Alliance Health Plan, care teams, resources, and services. Provide education and support to individuals and LRP in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance. Refer members who are in crisis or institutional setting and require assistance with returning to community-based services to the Integrated Health Consultant or applicable care team member. Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management Department. Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment or other assessments as deemed necessary. Coordinate with other team members to ensure smooth transition to appropriate level of care when needed. Communicate with member to check status, verify care needs are met, and that no new clinical needs warrant a change in condition assessment. Provide follow-up coordination with key stakeholders to promote engagement. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns or issues. Verify that ongoing service adherence is maintained through monitoring meetings with member and/or provider. Identify barriers to treatment and assist individuals with arranging appointments or linking to treatment providers. Maintain required contacts with member or legally responsible person per state contractual requirements meeting minimum expectations. Attend community, provider, stakeholder meetings as needed for member and/or as directed to support the needs of the health plan. Complete Documentation Obtain and upload all supporting documentation, Legally Responsible Person verification, and release of information that will improve care management activity on behalf of the member. Open new episodes in JIVA when needed and schedule initial contact with member to verify accuracy of demographic information. Document all applicable member updates and activities per organizational procedure. Escalate complex cases and cases of concern to immediate supervisor. Ensure that service orders or doctor’s orders are obtained, as applicable. Share appropriate documentation with all involved stakeholders as consent to release is granted. Obtain releases/documentation and provide to all stakeholders involved. Proactively respond to an individual’s planned movement outside the Alliance geographic area, or other transition need, to ensure a smooth transition without lapse in care. Ensure all clinical documentation meets state, agency documentation standards, and Medicaid requirements. Compliance with Alliance Policy and Procedure; adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures. Travel Travel between Alliance offices, attend meetings on behalf of Alliance, participate in Alliance-sponsored events, etc. may be required. Travel to meet with members, providers, stakeholders, attend court hearings, etc. is required. Minimum Requirements Education & Experience Bachelor’s degree from an accredited college or university in Human Services field and at least 2 years of post-bachelor’s experience with the population served. OR Bachelor’s degree from an accredited college or university in Non-Human Services field and at least 4 years of post-bachelor’s experience with the population served. OR Master’s degree from an accredited college or university in Human Services field and at least 1 year of post‑graduate experience with the population served. OR fully or provisionally licensed in the State of North Carolina as a LCSW, LCMHC, LPA, or LMFT. OR licensed Registered Nurse (RN) in the State of North Carolina with at least 4 years of experience with the population served. Preferred: NACCM, NADD–Specialist and/or CBIS Certification. Knowledge, Skills & Abilities Person Centered Thinking and planning. Knowledge of using assessments to develop plans of care. Knowledge of Diagnostic and Statistical Manual of Mental Disorders. Knowledge of LOC process, SIS for IDD and FASN assessment for TBI. Knowledge of Medicaid Tailored Plan, Medicaid Direct, enhanced MHSUD, and waiver benefits plans. Knowledge of and skill in the use of Motivational Interviewing. Proficient in Microsoft Office products (Word, Excel, Outlook, etc.). Strong interpersonal and written/verbal communication skills essential, including conflict management and resolution skills. High level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance. Ability to make prompt, independent decisions based upon relevant facts. Salary Range $28.96 – $37.65 per hour. 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, and Long Term Disability. Generous retirement savings plan. Flexible work schedules including hybrid/remote options. Paid time off including vacation, sick leave, holiday, and management leave. Dress flexibility. Employment for this position is contingent upon a satisfactory background and MVR (Motor Vehicle Registration) check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. 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. #J-18808-Ljbffr Alliance Health