Care Manager-Care Management for High-Risk Pregnancy (Hybrid, North Carolina)

The Care Management for High-Risk Pregnancy (CMHRP) Care Manager provides comprehensive, member-centered care management services for eligible high-risk pregnant members enrolled in Alliance Health’s Care Management for High-Risk Pregnancy program.

This position supports early identification, outreach, assessment, care planning, provider coordination, education, barrier resolution, social needs referrals, postpartum transition planning, and documentation in alignment with NCDHHS requirements and Alliance Health workflows.

This is a full-time hybrid opportunity. There is no expectation of coming into the office routinely, however, the selected candidate must be available to report onsite to the Alliance Office for business meetings as needed. The successful candidate may be required to travel within the Alliance communities throughout Cumberland County as needed.

Responsibilities & Duties

Provide Care Team Support

• Support members identified for CMHRP during pregnancy and postpartum, as designed
• 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, providers, primary care physicians, specialty care providers and other community partners and stakeholders to support members in their home communities and address barriers

Core CMHRP Management Functions

• Conduct timely outreach to members referred to or identified for CMHRP services using approved contact methods and engagement strategies
• Confirm eligibility, explain program services, support enrollment, document declinations or inability to contact, and notify appropriate providers when members enter the program
• Complete assessments to identify pregnancy-related risks, behavioral health needs, social drivers of health, barriers to prenatal care, member goals, and support needs
• Develop and maintain individualized, member-centered care plans in collaboration with the member, providers, and other supports as appropriate
• Provide education and care management support related to prenatal care engagement, warning signs, medication adherence, appointment follow-up, postpartum care, infant-related handoffs when applicable, and available community resources
• Identify and help resolve barriers such as transportation, food insecurity, housing instability, language access needs, behavioral health needs, substance use concerns, interpersonal safety concerns, and other health-related social needs
• Escalate urgent maternal health concerns, behavioral health crisis needs, safety concerns, missed high-risk appointments, or unresolved access barriers according to approved workflows

Monitoring/Coordination

• Coordinate with OB providers, Pregnancy Management Program providers, Advanced Medical Homes, hospitals, behavioral health providers, pharmacies, Local Health Departments, and community partners
• Participate in case reviews, supervision, quality audits, training, workflow refinement, and performance improvement activities

Documentation

• Document all outreach, assessment findings, care plans, referrals, provider communications, escalation actions, and case closure activities accurately and timely in the designated care management platform

Data

• Review, validate and interpret patient identification data, risk stratification data 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

Travel

• Travel between Alliance offices, attending meetings on behalf of Alliance, participating 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

Required:

Master’s degree from an accredited college or university in Human Services or related field and at least two (2) years of full-time, post graduate degree experience providing care management, case management, care coordination, discharge planning, or utilization management to members with Behavioral Health and Physical Health conditions in a behavioral health, medical, or managed care setting.

Must be fully or provisionally licensed in the State of North Carolina as a LCSW, LMFT, LCAS, LCMHC, LPA;

Or

Graduation from a school of nursing and licensure as a Registered Nurse and three (3) years of full-time, post degree experience.

Must be licensed as a Registered Nurse in the State of North Carolina.

Preferred:

Experience in care management, maternal health, high-risk pregnancy support, Medicaid managed care, behavioral health, community health, or human services is preferred.

Knowledge, Skills, & Abilities

• Knowledge of prenatal and postpartum care coordination, social drivers of health, behavioral health needs, community resources, and member engagement strategies preferred.
• Knowledgeable of the Tailored Plan and Medicaid Direct Transformation.
• Knowledge of Tailored Plan standards or procedures.
• Strong communication, engagement, documentation, organization, cultural responsiveness, problem-solving, and collaboration skills.
• Ability to build trust with members, coordinate across providers and community partners, manage multiple priorities, recognize escalation needs, use care management technology, and follow standardized workflows while adapting support to individual member needs.

Employment for this position is contingent upon a satisfactory background and MVR (Motor Vehicle Record) check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.

Salary Range

$69,592 - $88,729/ Annual

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, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility

Want to learn more about what it's like work as part of the Care Management Team? Click on our video to learn more: