Care Management Consultant

Provide Care Team Support Support members transitioning from institutional care settings to community-based care Provide subject matter expertise, within scope, regarding member’s physical and/or behavioral health to support the development and delivery of a whole person approach to Care Management Work collaboratively with other Alliance staff, behavioral health providers, primary care physicians, specialty care providers and other community partners and stakeholders to support members in their home communities Complete Assessments and Planning Utilize person-centered planning, motivational interviewing, and assessments to gather information and care planning Address concern(s) and/or questions from internal CM staff about the physical health/treatment/medications for our members Educate team members about impact of member’s health conditions on service engagement, clinical outcomes, and prognosis Actively collaborate with member and care team members to ensure care plan accurately reflects the individual’s clinical needs and desired life goals Collaborate with our internal Care Management staff and provide consultation regarding members with specialized physical health needs, transitions between care settings, and physical health needs identified via the assessments and care plan generation Provide medication reconciliation and education Consult with Pharmacy Team for Polypharmacy concerns as appropriate Provide Physical Health Consultation to Internal Care Management team members for questions related to member’s Physical Health (i.e., CHF, Diabetes) Medication Management The Physical Health Consultant will process and prioritize referrals from Care Management staff to ensure a medication reconciliation is completed Contact via phone or email the member and/or guardian to schedule an appointment to review member’s medications Review of members medical history to identify risk factors including recent hospitalizations, emergency room visits, seeing more than one physician, polypharmacy, or any new diagnoses Connect with members at scheduled appointment times via telephone or virtually Review and address Medication Adherence barriers Consult and elevate cases to Alliance’s Pharmacy team according to process and standard procedure Documentation Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements Follow administrative procedures and effectively manages caseload Data Review, validate and interpret risk stratification data and population health groups and recommend changes or adjustments to care management approach as needed Utilize data to analyze needs of the members we serve, guide staff training development, identify resource needs and consistency of workflow implementation across disciplines Requirements Graduation from an accredited school of nursing school and three (3) years of full-time, post degree experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions. Must have an active, valid RN license in North Carolina. Or Master’s degree from an accredited college or university in Occupational Therapy or Physical Therapy and two (2) years of full-time, post master’s degree experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions. Must have an active, valid OT or PT license in North Carolina. A demonstrated Knowledge of the assessment and treatment of mental health, substance abuse, intellectual and developmental disabilities. Knowledge of legal, waiver, accreditation standards and program practices/requirements. Knowledge of the Alliance Health service benefit plans and network providers. Person Centered Thinking/planning. The employee must be detail oriented. Ability to independently organize multiple tasks, priorities, and to effectively manage an assigned caseload under pressure of deadlines. Exceptional interpersonal skills, highly effective communication ability. Ability to make prompt independent decisions based upon relevant facts and established processes. Problem solving, negotiation and conflict resolution skills. Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required. Core Competencies Demonstrates expertise in Care Management and Case Coordination, with a focus on Behavioral and Physical Health conditions. Proficient in Person-Centered Planning, Medication Management, and effective communication with multidisciplinary teams. Highest-signal resume keywords Active RN License in North Carolina Care Management Experience Person Centered Planning Medication Management Behavioral Health Knowledge ATS Optimization Keywords Hard Skills Care Coordination Assessment and Planning Medication Reconciliation Data Analysis Risk Stratification Soft Skills Exceptional Interpersonal Skills Effective Communication Problem Solving Negotiation Skills Conflict Resolution Certifications & Qualifications Active OT License in North Carolina Active PT License in North Carolina Industry Keywords Behavioral Health Physical Health Person Centered Thinking Clinical Documentation Medicaid Requirements Tools & Technologies Microsoft Office Suite #J-18808-Ljbffr Jobtailor