Care Manager II (Full Time, Hybrid, Johnston County, North Carolina Based)

Position Overview The Care Manager II position leads all communication among care team members and is the primary point of contact for members served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. Work Structure Full‑time hybrid opportunity. The successful candidate must be available to report onsite to the Alliance Office for business meetings as needed and travel at least monthly throughout the Johnston County area to meet with members, providers, and other community stakeholders. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments. Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities. Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity. Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals/legally responsible persons in choosing service providers, ensuring objectivity in the process. Consistently evaluate the 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. Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals. Submit required documentation to UM to ensure timely delivery of services and troubleshoot until authorization is obtained; notify providers of successful authorization. Provide Support and Monitoring Schedule initial contact with member to verify accuracy of demographic information. Update inaccurate information from the Global Eligibility File. Schedule face‑to‑face meeting with member/LRP to provide education about Alliance, Care Teams, and services. Provide education and support, to individuals and LRP, about rights, the grievance and appeals process, available service options, providers and payer requirements that may impact service connection and maintenance. Refer members who are in crisis or institutional care settings and require assistance with returning to community‑based services to the Integrated Health Consultant. Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management. Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment. Coordinate with other team members to ensure smooth transition to appropriate level of care. Attend treatment meeting with member, natural supports and selected providers. Schedule, coordinate, and lead team conference calls on behalf of member needs. Communicate with member to check status, verify care needs are met, and ensure no new clinical needs warrant a change in condition assessment. Promote customer satisfaction through ongoing communication and timely follow‑up on any concerns/issues. Verify that ongoing service adherence is maintained through monitoring. Complete Documentation Obtain and upload all supporting documentation, LRP verification, and release of information that will improve care management activity on behalf of the member. Open new episodes in JIVA 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 Supervisor. Distribute surveys to members in service. Ensure that service orders/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. Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information. Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care. Ensure all clinical documentation (e.g., goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements. Travel Travel between Alliance offices, attending meetings on behalf of Alliance, and participating in Alliance‑sponsored events may be required. Travel to meet with members, providers, stakeholders, and attend court hearings is required. Minimum Requirements Education & Experience Master’s degree in Human Services or related field and at least two years of full‑time, post‑graduate degree, MH/SUD and/or Intellectual/Developmental Disabilities (I/DD) experience. Must be fully or provisionally licensed in the State of North Carolina as a LCSW, LMFT, LCAS, LCMHC, or LPA. OR Graduation from a school of nursing and licensure as a Registered Nurse, with two years of full‑time MH/SUD and/or I/DD experience, and active RN license in North Carolina. Physical Health Experience Preferred Graduate from a school of nursing and licensure as a Registered Nurse with two years of full‑time MH/SUD and/or I/DD experience. Knowledge, Skills, & Abilities Person centered thinking/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 basic, enhanced MHSUD, and waiver benefits plans. Knowledge of and skilled in the use of Motivational Interviewing. Proficient in Microsoft Office products (Word, Excel, Outlook, etc.). Strong interpersonal and written/verbal communication skills, 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 $68,227 - $88,695 per year. Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. Benefits 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. Employment Conditions Employment for this position is contingent upon a satisfactory background and MVR check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. Additional Information Want to learn more about what it's like to work as part of the Care Management Team? Click on our video to learn more: #J-18808-Ljbffr Alliance Health