Care Manager I – Waiver

🔥 12 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $28 - $37 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🦅 H1B Visa Sponsor

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Alliance Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Alliance Health is a regional health plan serving residents of several North Carolina counties by administering Medicaid and state-funded behavioral health and specialty services. It operates Tailored Plan coverage and Medicaid Direct options that integrate physical health, pharmacy, behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services, provides 24/7 behavioral health crisis support, member and provider portals, community trainings and outreach, and coordinates care through provider networks and governance committees.

📋 Description

• Provide integrated, whole-person, person-centered care management for individuals and families with special health care needs • Coordinate physical health, behavioral health, pharmacy, and unmet health-related resource needs • Complete comprehensive assessments and care needs screenings • Develop, assign, monitor, and update Plans of Care and Individual Service Plans • Coordinate referrals, authorizations, services, providers, community systems, and internal care team members • Support members and legally responsible persons with education, rights, grievances, appeals, service options, and payer requirements • Schedule and conduct face-to-face, virtual, and telephonic member meetings • Monitor service adherence, utilization, documentation, health status, progress, and individualized goals • Identify treatment and service barriers and assist with appointments and provider linkage • Coordinate SIS assessments, facility discharges, ISP meetings, waiver services, HCBS placements, purchase orders, and transitions • Conduct required in-person field-based service observations for Medicaid C services • Engage providers to resolve service-delivery and administrative barriers • Obtain, upload, maintain, and share required documentation and releases • Document member updates and activities in JIVA and maintain medical-record compliance • Escalate complex cases and concerns to supervisors • Report critical incidents, provider quality concerns, and changes in member health status • Travel to offices, member homes, provider locations, stakeholder meetings, court hearings, and Alliance-sponsored events as required • Ensure compliance with Alliance policies, procedures, state standards, and Medicaid requirements

🎯 Requirements

• Bachelor’s degree from an accredited college or university in Human Services field and two (2) years of post-bachelor’s degree mh/dd/sa experience with the population served, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; OR • Bachelor’s degree in a Non-Human Services field and four (4) years of post-bachelor’s degree mh/dd/sa experience with the population served, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; OR • Master’s Degree in a Human Services field and one (1) year of post graduate degree mh/dd/sa experience with the population served, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; OR • Fully or Provisionally Licensed in North Carolina as a LCSW, LCMHC, LPA, or LMFT and two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; OR • Licensed Registered Nurse (RN) in North Carolina with four (4) years of mh/dd/sa experience with the population served, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience • Preferred: NACCM, NADD-Specialist and/or CBIS Certification • Knowledge of person-centered thinking/planning, assessments, plans of care, LOC process, SIS for IDD, FASN assessment for TBI, Medicaid benefits and waiver plans • Skilled in Motivational Interviewing techniques • Strong interpersonal and written/verbal communication skills • Conflict management and resolution skills • Proficient in Microsoft Office products, including Word, Excel, and Outlook • High level of diplomacy and discretion • Ability to make prompt, independent decisions based upon relevant facts • Satisfactory background and MVR check after offer and before start date • Required driver license

🏖️ 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