Care Manager II

🔥 7 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $69.6k - $90.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🦅 H1B Visa Sponsor

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👻 Ghost score 0%

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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

• 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

🎯 Requirements

• 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

🏖️ Benefits

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