Care Manager II

🕒 vor 11 Tagen

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $69.592 - $90.469 / Jahr

⏰ Vollzeit

🟢 Junior

🟡 Mittelstufe

👔 Manager

🦅 H1B-Visum-Sponsor

Dieses Unternehmen hat in der Vergangenheit H1B-Visa gesponsert.

👻 Geisterscore 0%

Was es bedeutet: wie wahrscheinlich diese Stelle offen bleibt, ohne dass aktiv eingestellt wird.So liest du es: 60 % oder höher heißt, wir halten das für einen Geisterjob. Niedrigere Werte sind weniger bedenklich.Wie wir werten: Dauer offen, Neuveröffentlichungen, offene Stellen vs Teamgröße, wie schnell Stellen geschlossen werden, und ob ein Gehalt angegeben ist.Hinweis: eine Schätzung aus öffentlichen Daten, kein Urteil über das Unternehmen. Echte Stellen können hoch punkten, nutze es also als Hinweis, nicht als Fakt.

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Lebenslauf hochladen

Alliance Health

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 2012

🏥 Gesundheitswesen

⚕️ Krankenversicherung

Healthcare • Healthcare Insurance

Alliance Health ist ein regionaler Gesundheitsplan, der die Bewohner mehrerer Landkreise in North Carolina durch die Verwaltung von Medicaid und staatlich finanzierten verhaltensbezogenen Gesundheits- und Spezialdiensten versorgt. Es bietet maßgeschneiderte Planabdeckung und Medicaid Direct-Optionen, die körperliche Gesundheit, Pharmazie, Verhaltenstherapie, intellektuelle/entwicklungsbedingte Behinderungen (I/DD) und traumatische Hirnverletzungen (TBI) integrieren, bietet 24/7-Unterstützung bei Verhaltensgesundheitskrisen, Mitglieder- und Anbieterportale, Community-Schulungen und Öffentlichkeitsarbeit und koordiniert die Versorgung über Anbieternetzwerke und Verwaltungsräte.

Beschreibung

• Lead all communication among care team members and serve as the primary point of contact for the member • Complete comprehensive assessments at enrollment, annually, or upon changes in condition • Develop Plans of Care for Tailored Plan recipients • Assign interventions and Plan of Care activities to Care Workers and Community Health Workers • Submit referrals to Integrated Health Consultants for complex physical, behavioral health, or pharmaceutical needs • Assist individuals and legally responsible persons in choosing service providers objectively • Evaluate service appropriateness and ensure Plan of Care implementation • Use person-centered planning, motivational interviewing, and historical Jiva assessment reviews to identify needed supports • Collaborate with care teams, members, and service providers to develop individualized plans • Submit required documentation to Utilization Management and troubleshoot authorization issues • Schedule and conduct member contacts, face-to-face meetings, education, and support • Explain rights, grievance and appeals processes, service options, providers, and payer requirements • Recognize and report critical incidents and provider quality concerns • Coordinate transitions to appropriate levels of care and attend treatment meetings • Schedule, coordinate, and lead team conference calls • Monitor member status, care needs, service adherence, and emerging clinical needs • Obtain, upload, and share supporting documentation, releases, consents, and legal/guardianship verification • Open episodes in JIVA and document member updates and activities • Escalate complex cases to the Supervisor and distribute member surveys • Obtain service orders and clinical documentation as applicable • Coordinate transitions when individuals move outside the Alliance MCO geographic area • Ensure documentation meets state, agency, and Medicaid requirements • Travel between Alliance offices and to members, providers, stakeholders, and court hearings as required

🎯 Anforderungen

• 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 North Carolina as an LCSW, LMFT, LCAS, LCMHC, or LPA • OR graduation from a school of nursing, active Registered Nurse licensure, and two years of full-time MH/SUD and/or I/DD experience • Must be licensed as a Registered Nurse in North Carolina • Physical Health experience preferred • Knowledge of Person Centered Thinking/planning • Knowledge of using assessments to develop plans of care • Knowledge of the 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 • Skilled in Motivational Interviewing • Proficient in Microsoft Office products such as Word, Excel, and Outlook • Strong interpersonal and written/verbal communication skills, including conflict management and resolution • High level of diplomacy and discretion • Ability to make prompt, independent decisions based on relevant facts • Must reside in North Carolina • Must be willing to travel to offices for business or onsite team meetings as needed

🏖️ Vorteile

• Full-time remote work • Travel to Alliance offices, meetings, sponsored events, member/provider/stakeholder meetings, and court hearings as required • Equal opportunity employer