Care Manager II

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Facilitate all communications among care team members and act as the main point of contact for the member.

• Conduct thorough assessments at the time of enrollment, annually, or when there are changes in the member's condition.

• Create Plans of Care for recipients of the Tailored Plan.

• Delegate interventions and activities outlined in the Plan of Care to Care Workers and Community Health Workers.

• Refer complex physical, behavioral health, or pharmaceutical needs to Integrated Health Consultants.

• Support individuals and their legally responsible representatives in making objective choices regarding service providers.

• Assess the appropriateness of services and ensure the execution of the Plan of Care.

• Utilize person-centered planning, motivational interviewing, and historical Jiva assessment reviews to pinpoint necessary supports.

• Collaborate with care teams, members, and service providers to create tailored plans.

• Submit all required documentation to Utilization Management and resolve authorization challenges.

• Organize and perform member contacts, in-person meetings, education sessions, and provide support.

• Clarify rights, grievance and appeals processes, available service options, providers, and payer requirements.

• Identify and report critical incidents and concerns regarding provider quality.

• Facilitate transitions to suitable levels of care and participate in treatment meetings.

• Schedule, organize, and lead team conference calls.

• Monitor member status, care requirements, service compliance, and emerging clinical needs.

• Collect, upload, and share necessary documentation, releases, consents, and guardianship verification.

• Initiate episodes in JIVA and record member updates and activities.

• Elevate complex cases to the Supervisor and distribute member surveys.

• Acquire service orders and clinical documentation as necessary.

• Manage transitions when individuals relocate outside the geographic area of the Alliance MCO.

• Ensure documentation adheres to state, agency, and Medicaid standards.

• Travel between Alliance offices and to members, providers, stakeholders, and court hearings as required.

⛳️ Requirements

• A Master's degree in Human Services or a related field, along with a minimum of two years of full-time, post-graduate experience in Mental Health/Substance Use Disorders (MH/SUD) and/or Intellectual/Developmental Disabilities (I/DD).

• Must possess either a full or provisional license in North Carolina as an LCSW, LMFT, LCAS, LCMHC, or LPA.

• OR must have graduated from a nursing program, hold an active Registered Nurse license, and have two years of full-time experience in MH/SUD and/or I/DD.

• Must be a licensed Registered Nurse in North Carolina.

• Preferred experience in Physical Health.

• Familiarity with Person Centered Thinking/planning.

• Knowledge in utilizing assessments for developing plans of care.

• Understanding of the Diagnostic and Statistical Manual of Mental Disorders.

• Awareness of the LOC process, SIS for IDD, and FASN assessment for TBI.

• Knowledge of Medicaid's basic, enhanced MHSUD, and waiver benefits plans.

• Proficient in Motivational Interviewing techniques.

• Skilled in Microsoft Office applications, including Word, Excel, and Outlook.

• Excellent interpersonal and written/verbal communication skills, including conflict management and resolution abilities.

• High degree of diplomacy and discretion.

• Capability to make timely, independent decisions based on relevant information.

• Must reside in North Carolina.

• Willingness to travel to offices for business purposes or on-site team meetings as necessary.

🏝️ Benefits

• Opportunity for full-time remote work.

• Travel to Alliance offices, meetings, sponsored events, member/provider/stakeholder meetings, and court hearings as needed.

• Equal opportunity employer.