The Care Manager l-Non-Waiver assures that individuals and families with special health care needs receive integrated whole-person care management, including coordinating across physical health, behavioral health, pharmacy and unmet health-related resource needs to ensure they are linked to services and supports in an effort to maximize potential outcomes and decrease the unnecessary use of hospitals and emergency services by assuring that appropriate quality care is in place.
The Care Manager I – Non-Wavier focuses on a specified population of members utilizing health care services while ensuring all member health needs and referrals are attended to. The Care Manager l will collaborate with other community systems to work in partnership to support the identified population.
This is a full-time hybrid opportunity. There is no expectation of coming into the office routinely, however, the selected candidate must be available to report onsite for business meetings as needed and for weekly travel to the Home office to serve Alliance members as needed.
Responsibilities & Duties
Complete Assessment/Planning
Complete comprehensive assessments or Care Needs Screening at enrollment, yearly or at changes in condition.
Develop Plans of Care derived from the completed assessments
Demonstrate commitment to whole person/integrated care
Assign interventions/plans of care to applicable Alliance Care Management team member to meet identified member needs, for monitoring, and/or service engagement activities
Submit referrals to the Transition Coordinator 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; 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
Assist in collecting data to be used to identify and address barriers as well as determine the effectiveness of care management/care coordination in reducing lengths of stay and use of emergency services
Actively collaborate with members/legally responsible person, care team, service providers, and identified supports to ensure development of a plan that accurately reflects the individual’s needs and desired life goals including collaborating with residential placement search in conjunction with internal team members or external stakeholders as needed
Submit required documentation to UM to ensure timely delivery of services and trouble shoot until authorization is obtained. Notify a member’s care team and providers of successful authorization (for residential or waiver related services)
Provide Support and Monitoring to Members
Schedule initial contact with member for purpose of assessment and engagement
Verify accuracy of demographic information with member. Update inaccurate information from the Global Eligibility File following documented protocols
Schedule face to face, virtual, and telephonic meeting with member/guardian to provide education about Alliance Health Plan, care teams, resources, 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 setting and require assistance with returning to community based services to the Integrated Health Consultant or applicable care team member
Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management Department
Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment or other assessments as deemed necessary
Coordinate with other team members to ensure smooth transition to appropriate level of care when needed
Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment
Provide follow up coordination with key stakeholders to promote engagement
Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues
Verify that ongoing service adherence is maintained through monitoring meetings with member and/or provider
Identify barriers to treatment and assist individuals with arranging appointments or linking to treatment providers
Maintain required contacts with member/legally responsible person per state contractual requirements meeting minimum expectations
Attend community, provider, stakeholder meetings as needed for member and/or as directed to support the needs of the health plan
Complete Documentation
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 when needed 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 immediate supervisor.
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 provide to all stakeholders involved
Proactively respond to an individual’s planned movement outside the Alliance geographic area, or other transition need, to ensure a smooth transition without lapse in care
Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements
Minimum 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
Or
Bachelor’s degree from an accredited college or university in Non-Human Services field and four (4) years of post-bachelor’s degree mh/dd/sa experience with the population served
Or
Master’s Degree from an accredited college or university in Human Services field and one (1) year of post graduate degree mh/dd/sa experience with the population served
Or
Fully or Provisionally Licensed in the State of North Carolina as a LCSW, LCMHC, LPA, or LMFT
Or
Licensed Registered Nurse (RN) in the State of North Carolina with four (4) years of mh/dd/sa experience with the population served
Preferred:
NACCM, NADD-Specialist and/or CBIS Certification
Experience with the IDD population
Knowledge, Skills, & Abilities
Person Centered Thinking/planning
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 Tailored Plan, Medicaid Direct, 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, including
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
Salary Range
$28.12 to $36.55/Hourly
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long and Short 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
Want to learn more about what it's like work as part of the Care Management Team? Click on our video to learn more:https://youtu.be/1GZOBFx61QU
