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

Responsibilities

• Complete Assessment/Planning
  • 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.
  • Affirmatively 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.
  • 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 to 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.
  • Notify providers of successful authorization.
• Support and Monitoring
  • Schedule initial contact with member to verify accuracy of demographic information.
  • Update inaccurate information from the Global Eligibility File.
  • Provide education about Alliance, Care Teams, 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/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.
• Documentation
  • Obtain and upload all supporting documentation, Legally Responsible Person (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.
  • 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, participating in Alliance sponsored events, etc. may be required.
  • Travel to meet with members, providers, stakeholders, attend court hearings etc. is required.

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, LPA; Or Graduation from a school of nursing and licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active.
  • Must be licensed as a Registered Nurse in the State of North Carolina.
• Physical Health Experience: Preferred
• 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 and skilled in the use of Motivational Interviewing
  • Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
  • Strong interpersonal and written/verbal communication skills essential, including Conflict management and resolution skills
  • High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance
  • Ability to make prompt, independent decisions based upon relevant facts

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

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.