Care Manager II

🕒 il y a 11 jours

🌲 North Carolina – Distant

🌲 North Carolina – Remote

💵 $69 592 - $90 469 / an

⏰ Temps Plein

🟢 Junior

🟡 Intermédiaire

👔 Manager

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

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Alliance Health

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 2012

🏥 Santé

⚕️ Assurance santé

Healthcare • Healthcare Insurance

Alliance Health est un plan de santé régional dessert les résidents de plusieurs comtés de Caroline du Nord en administrant les services de santé comportementale et spécialisés financés par l'État et Medicaid. Elle opère une couverture Tailored Plan et des options Medicaid Direct qui intègrent la santé physique, la pharmacie, la santé comportementale, le handicap intellectuel/développemental (I/DD) et les services de traumatisme crânien (TBI), fournit un soutien de crise en santé comportementale 24/7, des portails pour les membres et les prestataires, des formations communautaires et des activités de sensibilisation, et coordonne les soins à travers des réseaux de prestataires et des comités de gouvernance.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

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