Care Transitions Care Manager – Mid-State

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

📋 Description

• Deliver in-reach and transitional care management for members in institutional, congregate, or facility-based environments, including ACHs, hospitals, inpatient units, and other qualifying locations.

• Educate members, families, and guardians on navigating physical, behavioral, and social service systems as well as available informal/community resources.

• Facilitate access to community resources for members and guardians.

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

• Provide guidance and oversight to providers concerning social determinants, medical needs, and other member requirements.

• Complete all necessary documentation, paperwork, and tasks in Trillium’s software platform within established timeframes.

• Collaborate within an interdisciplinary team addressing the Olmstead Settlement and Tailored Plan.

• Evaluate and monitor member health and safety, especially during state emergencies or weather advisories.

• Offer age- and developmentally appropriate education on integrated community-based care and available services.

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

• Create opportunities for members and guardians to connect with individuals diagnosed with SMI/SPMI who are living, working, and receiving services in community settings.

• Identify, document, and strive to overcome barriers to transitioning to integrated community settings.

• Engage members in State Psychiatric Hospitals and ACHs regarding permanent supportive housing, supports, services, and community resources.

⛳️ Requirements

• Must fulfill QP status.

• One of the following qualification paths: fully licensed by the NC governing board overseeing Human Services professions; fully licensed RN authorized to practice in North Carolina with four years of full-time experience in the MH/DD/SA population; master's degree in a human service field with one year of full-time experience in MH/DD/SA; bachelor's degree in a human service field with two years of full-time MH/DD/SA experience; or a bachelor's degree in a different field with four years of full-time experience in MH/DD/SA.

• Substance abuse professional alternatives necessitate the specified supervised experience in alcoholism and drug abuse counseling.

• Must possess a valid driver’s license.

• Must reside within Trillium’s Mid State Region: Anson, Guilford, Montgomery, Randolph, or Richmond County, North Carolina.

• Must be able to travel within the designated area as needed.

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

• Resume must detail employer names, dates of service, average weekly hours, key responsibilities, educational background, and licensure/certification information where applicable.

🏝️ Benefits

• Competitive benefits package.

• Work-from-home options available for most positions.

• Flexible work schedules with some roles requiring management approval.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

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

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

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

• Public Service Loan Forgiveness (PSLF) qualifying employer.

• Quarterly stipend for remote work supplies.