Care Transitions Care Manager

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

📋 Description

• Deliver in-reach and transition care management to members residing in institutional, congregate, or facility-based environments, such as hospitals and inpatient units.

• Educate members and their guardians on how to navigate physical, behavioral, and social service systems while accessing informal and community resources.

• Create care plans grounded in national evidence-based practices and informed standards for comprehensive whole-person care.

• Guide and oversee providers regarding the social determinants of health, medical, and other needs of members.

• Complete all necessary documentation, paperwork, and software-related tasks within established deadlines.

• Collaborate with an interdisciplinary team to address functions related to the Olmstead Settlement and Tailored Plan.

• Assess and monitor the health and safety of members, including during state emergencies or severe weather advisories.

• Provide education that is age- and developmentally appropriate concerning integrated community-based care and available services.

• Manage complex care in accordance with NCQA and other regulatory/accreditation standards.

• Facilitate opportunities for peers with SMI/SPMI diagnoses who are living, working, and receiving community services.

• Identify, document, and address obstacles to relocating individuals to integrated community settings.

• Engage residents of State Psychiatric Hospitals and ACHs regarding supportive housing, services, and community resources.

⛳️ Requirements

• Must possess QP status.

• Fully licensed by the NC governing board overseeing Human Services professions; OR fully licensed RN authorized to practice in North Carolina by the NC Board of Nursing with four years of full-time experience in the MH/DD/SA population; OR a master’s degree in a human service field with one year of full-time MH/DD/SA experience; OR a bachelor’s degree in a human service field with two years of full-time MH/DD/SA experience; OR a bachelor’s degree in another discipline with four years of full-time MH/DD/SA experience.

• Alternatives for substance abuse professionals must include the required supervised experience in alcoholism and drug abuse counseling.

• If serving members with LTSS needs, a minimum of two years of prior experience in LTSS and/or HCBS coordination, care delivery monitoring, and care management is required.

• A valid driver’s license is mandatory.

• Must reside within Trillium’s Northern Region, which includes Bertie, Camden, Chowan, Currituck, Gates, Halifax, Hertford, Martin, Northampton, Pasquotank, Perquimans, and Warren counties.

• Ability to travel within the service area as needed.

• All candidates must successfully pass a drug test as a condition of employment.

🏝️ Benefits

• A collaborative, mission-driven work environment.

• Competitive benefits and work-from-home options available for most positions.

• Opportunities for professional advancement within a diverse and inclusive culture.

• Flexible work schedules available for some roles with management approval.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO) along with 12 paid holidays in your first year.

• NC Local Government Retirement Pension (defined-benefit plan).

• 401k plan with a 5% employer match and immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend provided for remote work supplies.