IDD Community Integration Care Manager (Full Time, Hybrid, Mecklenburg County, North Carolina Based)

IDD Community Integration Care Manager (Full Time, Hybrid, Mecklenburg County, North Carolina) Provide critical support to Alliance members with intellectual and developmental disabilities (I/DD) to transition from an institutional setting into independent community living of their choice. Build relationships and rapport with members and providers, coordinate ongoing support during and after the transition into community, and facilitate continued success in a community setting. Requires facility and home visits, as well as monthly travel throughout North Carolina to meet members, providers, and state developmental centers. Locations Mecklenburg Office 8520 Cliff Cameron Drive, Ste 300 Charlotte, NC 28269, USA Key Responsibilities Assessment & Monitoring Document member and/or legally responsible person (LRP) consent to participate in the transition process and care management efforts. Complete assessment of member preferences and needs within defined timelines using active listening, motivational interviewing, and open‑ended questions. Assess the whole person—physical, psychological, social, environmental, and spiritual needs. Collaborate with caregivers, providers, and the interdisciplinary team, as appropriate and with consent, to inform the assessment. Document assessment findings, including support systems, primary concerns, strengths, priorities, care needs gaps, and social needs. Document member and/or LRP agreement regarding identified care needs, opportunities, and goals for intervention. Monitor member condition and response to the care plan and interventions using data related to resource utilization and quality metrics. Document collaboration and engagement with the member, LRP, and others involved in the member’s care and support. Document new findings, barriers to care, and effectiveness of the current care plan, noting member understanding and agreement. Follow up routinely and ad‑hoc to monitor progress toward goals and revise goals appropriately. Collaborate with member/LRP to determine appropriate time to end the episode of care once the member has transitioned into community living of their choice. Care Planning Develop a member‑centric, agreed‑upon care plan based on assessment and member‑identified priorities. Use a collaborative partnership approach responsive to the member’s culture, preferences, needs, and values. Develop a comprehensive, holistic, and compassionate care plan integrating medical, behavioral, social, psychological, functional, and other needs. Consider barriers and opportunities when developing the care plan. Include prioritized goals and outcomes with associated interventions in collaboration with the member and their support network. Make revisions or modifications to the care plan as needed, reviewing with the member for understanding and agreement. Facilitate awareness of and connections with community supports and resources. Refer to community and social support services, assist with applications, and follow up to maintain resources. Help members navigate the healthcare system to enhance timely access to services and achieve desired outcomes. Coordinate care, services, resources, and health education as specified in the planned interventions. Maintain ongoing communication and collaboration with the member’s support systems and the interprofessional health team. Document facilitation, coordination, and collaboration to support transitional care management activities. Facilitate connections with community, state resources, primary care providers, and other stakeholders. Document transparent communication with the healthcare team. Advocacy Adhere to member privacy and confidentiality mandates in all facilitation, coordination, communication, and collaboration activities. Provide education and guidance on self‑determination, shared decision making, autonomy, and self‑advocacy. Connect members and informal caregivers to education and training to improve function and system navigation. Explain rights, protections, and responsibilities, including provider change rights and complaint resolution processes. Educate other providers on recognizing and respecting member needs, strengths, and goals. Identify and eliminate disparities in accessing high‑quality care. Advocate for least restrictive appropriate levels of care, timely transitions, and optimal allocation of resources. Identify system barriers and elevate them to direct supervisor for additional support. Recognize potential rising risk or escalation and seek consultation with clinical operations and leadership. Participate in interdisciplinary care team rounds, high‑risk member committees, and other consultations as appropriate. Health Promotion Assess readiness for change and provide appropriate health education aligned to member’s health literacy. Integrate behavioral change skills throughout the care management process. Provide health education on acute and chronic conditions to prevent adverse outcomes. Assess environmental impacts on health, educate, and connect to resources to mitigate barriers. Monitor for gaps in care, educate on importance of health promotion and early detection. Coordinate follow‑up on identified gaps, identify resources to remove barriers. Encourage participation in healthy activities, such as healthy eating, exercise, tobacco cessation, stress management, weight management, and community engagement. Teach self‑management skills and share self‑help recovery resources; work with members on SMART goals. Document member engagement, progress with SMART goals, and revise as needed. Assess and document member response and understanding of education provided. Professional Accountability Conduct oneself in a professional manner aligned with Alliance values. Document in accordance with guidelines, regulatory and organizational standards. Meet performance and productivity expectations and metrics. Maintain timely routine and ad‑hoc outreach and engagement. Complete assessments and care planning within timelines and based on triggering events. Obtain and/or maintain required licensure and certifications through professional development. Pursue professional knowledge and best practices in case management and health delivery. Maintain compliance with federal, state, and local rules and accreditation standards. Demonstrate knowledge and competency in case management standards, ethics, and conduct. Education & Experience Must meet North Carolina’s definition of a Qualified Professional (QP) per 10A‑NCAC 27G.0104. Master’s degree in a human services field with at least one (1) year of post‑graduate I/DD experience. OR Bachelor’s degree in a human services or related field with at least two (2) years of post‑graduate I/DD experience. OR Bachelor’s degree in a non‑human services field with at least four (4) years of post‑graduate I/DD experience. At least one (1) year of experience in a healthcare setting with an integrated whole‑person care model (physical and behavioral health). National Association of and Dual Diagnosis (NADD) Specialist certification required within 12 months of hire. Preferred Qualifications Completion of Money Follows the Person Transitions Institute training. Experience working with individuals with I/DD in a facility‑based setting. Certified Case Manager. Knowledge, Skills & Abilities Applied knowledge of community‑based DSP training. Practical communication skills, including active listening, motivational interviewing, and open‑ended questioning. Ability to analyze assessment findings and determine care needs, barriers, or gaps. Proficiency with problem‑solving techniques to reconcile differing viewpoints. Computer proficiency in Microsoft Word, Teams, Outlook, and basic knowledge of Excel. Ability to use computer equipment and web‑based software for work. Strong interpersonal skills to interact with office staff, healthcare professionals, patients, and families. Effective written and electronic communication skills. Excellent attention to detail, prioritization, and task execution. Independent working ability with minimal supervision. Knowledge and application of behavioral change skills and standards. Knowledge of Home‑Based Community Services (HCBS) benefits, services, and waivers. Salary & Benefits Salary: $28.96 – $36.92 per hour, determined based on education, experience, market data, and internal equity. Generous retirement savings plan. Flexible work schedules, including hybrid/remote options. Paid time off: vacation, sick leave, holiday, management leave. Dress flexibility. Employment Conditions Employment is contingent upon a satisfactory background and Motor Vehicle Registration (MVR) check performed after an offer is accepted 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