Care Manager II (Hybrid, North Carolina based)

About the position

The Care Manager II position at Alliance Health is responsible for leading communication among care team members and serving as the primary point of contact for members in Mecklenburg County. This role involves conducting comprehensive assessments, developing unified care plans, and ensuring effective service delivery while collaborating with various stakeholders. The position allows for a hybrid work schedule, combining remote work with community engagement as directed by the supervisor.

Responsibilities

• Complete 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.
• Assist individuals/legally responsible persons in choosing service providers; ensuring objectivity in the process.
• Consistently 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.
• Submit required documentation to UM to ensure timely delivery of services and troubleshoot until authorization is obtained. Notify providers of successful authorization.
• Schedule initial contact with member to verify accuracy of demographic information.
• Update inaccurate information from the Global Eligibility File.
• Schedule face to face meeting with member/LRP to 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.
• Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment.
• Coordinate with other team members to ensure smooth transition to appropriate level of care.
• Attend treatment meeting with member, natural supports and selected providers.
• Schedule, coordinate and lead team conference calls on behalf of member needs.
• Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment.
• Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.
• Verify that ongoing service adherence is maintained through monitoring.
• 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.
• Obtain releases/documentation and provides to all stakeholders involved.
• Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information.
• 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.

Requirements

• Valid full or provisional NC clinical licensure.
• Master's degree from an accredited college or university 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 and active, valid NC clinical licensure as a LCSW, LCMHC, LPA, or LMFT.
• Graduation from a school of nursing with valid NC licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience.
• Physical Health experience preferred.

Nice-to-haves

• 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 of 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.
• 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