Alliance Health

• Analyze Care Management documentation and activities to ensure compliance • Review the quality-of-Care Management internal processes/plans and provider information, such as Person-Centered Plans or chart notes, for alignment with procedures and/or best practices • Audit Care Management clinical documentation, case interventions, and, if available, staff phone recordings to ensure alignment with program descriptions, workflows, internal policies, evidence based clinical guidelines, NCQA guidelines, CMS guidelines, and regulatory guidelines (when applicable) • Identify and escalate situations which may pose quality, compliance, and safety risks that may adversely affect business operation • Evaluate clinical appropriateness of decisions, recommendations, and actions within Care Management documentation • Interpret qualitative and quantitative information to appropriately document findings • Make recommendations for improvement related to any records reviewed and write reports of findings • Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA standards, applicable state and Federal laws and regulations • Analyze Data and Report on findings • Generate monthly Care Management Quality reports on Staff performance to submit to Directors, Managers, and Supervisors • Provide written feedback to Directors, Managers and Supervisors concerning quality concerns pertaining to individual performance, compliance risks/trends, root cause analysis and any system or process improvements recommended • Evaluate knowledge gaps of staff and coordinate training • Evaluate knowledge gaps of the staff and collaborate with Care Management Leadership to coordinate learning and training opportunities with the Care Management Training team • Monitor training of staff for effectiveness and impact of outcomes from enhanced training

Role Description The Classification and Compensation Manager is responsible for managing the classification and compensation functions for the organization. This position plans, develops, and implements new and revised compensation programs, policies, and procedures to align with the organization’s goals and competitive practices. The manager ensures that company compensation programs are consistently administered in compliance with internal policies and government regulations. This is a fulltime remote position. Selected candidate must reside in North Carolina. While there is no expectation of being in the office routinely, they may be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as needed. Responsibilities & Duties - Manage The Classification and Compensation Plan - Manage the Pay Structure to ensure job classifications and salary levels are captured accurately and are up to date. - Manage the administration of the compensation system to ensure consistent and equitable compensation among positions. - Monitor the effectiveness of existing compensation practices and recommend changes that are cost-effective and consistent with compensation trends within the industry and organizational objectives. - Manage compensation studies and salary surveys under the guidance of the Director of Talent Acquisition and Compensation. - Ensure compliance with federal, state, and local compensation laws, regulations, and contracts. - Conduct salary reviews to ensure the organization is competitive with market trends. - Advise staff on pay decisions, policy interpretations, and job evaluations. - Manage the maintenance of all relevant tracking and reporting systems to accurately capture the flow of relevant data being processed by the team. - Manage the Creation of New Jobs and Positions and Manage Changes to Existing Jobs and Positions - Collaborate with Department leadership on creation of new jobs and departmental structure changes. - Assist leaders with the development of job descriptions for each job in the organization. - Manage the job analysis process to determine FLSA classification and salary level for each job in the organization. - Ensure jobs are classified and leveled appropriately based on the specifications of the job. - Develop and Maintain Compensation Policies, Procedures, Programs, and Workflows - Design creative solutions to specific compensation-related programs and incentive plans. - Assist with the development and maintenance of compensation policies and procedures. - Analyze and refine desk procedures and workflows to improve department operations. - Develop written guides and presentations to assist in communicating and clarifying the processes, policies, and procedures to leaders and staff. - Manage and Develop Staff - Work with the Senior Director of Human Resources to recruit and retain a highly qualified and well-trained Classification and Compensation team. - Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes. - Organize workflows and ensure staff understand their roles and responsibilities. - Ensure the department has the needed tools and resources to achieve organizational goals. - Actively establish and promote a positive, diverse, and inclusive working environment. - Ensure all staff are treated with respect and dignity. - Ensure standards are transparent and applied consistently, impartially, and ethically for all team members. - Work to resolve conflicts and disputes among team. - Set goals for performance and deadlines in line with organization goals and vision. - Effectively communicate feedback and provide ongoing coaching and mentoring to staff. - Cultivate and encourage efforts to expand cross-team collaboration and partnerships. - General HR - Manage the handling of and responses to relevant cases submitted to the HR case management system. - Manage HR records according to area of responsibility by ensuring files are updated, accurate and properly documented. - Ensure employees and leaders have appropriate training and materials to assist with processes related to area of responsibility. - Assist in developing, implementing, and administering relevant HR programs and initiatives. Qualifications - Bachelor’s degree from an accredited college or university in Human Resources, Business Administration, Psychology, Sociology, or related field. - Four (4) years of experience in Human Resources including at least one (1) year of supervisory leadership experience. - Experience must include creating and maintaining job descriptions, classifying and leveling jobs into salary bands, and leading or supporting compensation studies. - Experience managing complex data in Microsoft Excel required. Requirements - Experience working as a Compensation Manager and HR Certification strongly preferred. Knowledge, Skills, & Abilities - Knowledge of classification and compensation practices. - Knowledge of employment-related laws and regulations. - Knowledge of Human Capital Management systems. - Verbal and written communication skills. - Organizational skills and attention to detail. - Time management skills with a proven ability to meet deadlines. - Analytical and problem-solving skills. - Ability to prioritize tasks and delegate tasks when appropriate. - Interpersonal and conflict resolution skills. - Ability to act with integrity, professionalism, and confidentiality. - Microsoft Office Suite. Salary Range $89,404 - $113,990/ Annually. Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 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.

• Support the month-end close by preparing journal entries, reconciling accounts, and ensuring accuracy across key financial areas, including cash, prepaid expenses, and fixed assets. • Support the annual audit process by preparing schedules and providing necessary documentation. • Record journal entries into the accounting system • Prepare monthly accruals, reclasses, and allocations • Maintain Prepaid and Asset schedules and record monthly journal entries • Analyze expenses to ensure all fixed assets and prepaids are properly classified • Provide support with balance sheet reconciliations. • Provide support with balance sheet and bank reconciliations • Respond to various ad hoc reporting requests, ensuring accuracy and timely delivery of data • Accurately record and document all incoming cash transactions on a daily basis • Process and record monthly Accounts Receivable (A/R) invoices related to administrative revenue • Propose write-off recommendations for uncollectable A/R • Monitor and analyze current processes and schedules to develop more efficient procedures and use of resources while maintaining a high level of accuracy

• Validate and Approve TBI, Innovation Waiver, 1915(i), and LTCS Sites and Services • Review and validate service site documentation for TBI, Innovation Waiver, 1915(i), and LTCS programs; confirm compliance with regulatory standards to authorize member access to new or existing service locations • Perform HCBS reviews as required and within the required timeframes • Review provider policies and procedures for compliance with CMS mandated HCBS standards • Review and manage HCBS portal to ensure portal entries are reviewed and accepted prior to service initiation and move in • Collaborate with other MCOs when a member is transferred into the Alliance catchment area or transferred out of the Alliance catchment area • Work with providers to ensure out of compliance findings are remedied either by providing technical assistance and/or through a plan of correction • Work with I/DD Care Coordination, Provider Network Development and agency providers to ensure sites are validated and in compliance • Remediate issues and concerns that are identified by the State with MIE surveys through documentation review, technical assistance with providers and other stakeholders, and collaboration with I/DD Care Coordinators • Provide reports and updates on outcomes of reviews of HCBS and the potential impact on consumers involved to the Provider Network Evaluator Supervisor and/or the Director of Network Evaluation • Review self-directed services (Employer of Record) on an annual basis as required • Maintain a current database of HCBS sites that require monitoring and review • Maintain a database of unlicensed AFL sites that require annual reviews

• Serve as the primary liaison with the Division of Social Services • Coordinate outreach, distribute materials, understand the scope of services and programs • Coordinate through local DSS offices • Triage and escalate member specific or BH I/DD Tailored Plan questions • Assist Members with gaining access to services • Provide education, coordination, triage/escalation support, and technical assistance • Collaborate with member’s assigned Care Manager for coordination across member supports, providers, and community service agencies • Address barriers to accessing resources, services, and programs • Participate in treatment team meetings as needed with the member’s Care Team • Provide recommendations to improve access to services and coordination of care between Alliance and DSS • Coordinate care with DSS • Participate in regular meetings with DSS representatives to review placement/service needs and barriers • Travel between Alliance offices, meetings on behalf of Alliance, and to meet with members, providers, stakeholders, and attend court hearings as required

• Complete comprehensive assessments or Care Needs Screening at enrollment, yearly or at changes in condition • Develop Plans of Care derived from the completed assessments • 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 CCM when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity • Assist individuals/legally responsible persons in choosing service providers; 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 • 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 consistent with best practices and working through the permanent supportive housing model • 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

• Serve as the project management lead and subject matter expert for NCQA standards • Manage the assessment of related business functions for corresponding departments • Implement and monitor accreditation workplan • Identify gaps and risks and provide regular status reports • Serve as lead for NCQA Accreditation reviews by gathering necessary documents • Review and update policies and procedures, reports, and materials for compliance • Provide technical support and education to staff regarding NCQA Health Plan Accreditation • Assess business area functions against NCQA standards • Identify and facilitate process improvements • Communicate reporting due dates and reminders to business leads • Lead compliance review for non-clinical standards

Role Description The UM Clinical Specialist-Behavioral Health performs professional and administrative work, primarily utilization reviews, utilization management, and active care management to ensure economical and effective consumer service delivery by PHIP enrolled network providers. The position is responsible for providing medical necessity reviews of individualized service plans and requests for authorization of services to ensure consumers receive services in the least restrictive, most integrated setting appropriate to the individual’s needs. The primary role is to review for services under the Medicaid B waiver and state-funded benefits; complete related work as required. This position is full-time remote. The selected candidate must reside in North Carolina. Some travel for onsite meetings may be required. Responsibilities & Duties - Utilization Reviews and Management - Independently conducts medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times. - Conducts utilization reviews to monitor adherence to clinical practice guidelines and best practice standards and to determine if services were delivered as requested. - Engages in care management activities to ensure individuals receive appropriate referral for treatment including consumer and provider follow-up calls, case staffing with psychologists and medical staff. - Monitors consumer person-centered plans to ensure that effective treatment interventions are utilized, providing consultation to treating providers when person-centered plans require adjustments to better meet consumer needs. - Monitors and reports consumer and provider specific over/under utilization. - Conducts utilization reviews to monitor for over/under utilization. - Program Operation and Management - Identifies high-risk consumers and those with special health care needs for referral to Care Coordination and case escalation. - Provides linkage, authorizations, and level of care determinations, assisting providers and Care Coordinators with creative problem solving to recommend alternative approaches to care. - Ensures compliance with care management and quality improvement policies and procedures, utilization review laws and regulations, state standards. - Promotes access to appropriate, effective, and quality treatment. - Monitors for undesirable performance or deviations of practice standards through care management activities that may have a negative impact on consumers. Responds through additional follow-up with consumers and providers, provider technical assistance, and/or referral to other departments within the MCO. - Administrative Functions - Notifies members of adverse benefit determinations while preserving members’ Due Process rights. - Engages in routine follow-up to ensure consumers are engaged in treatment and services are being delivered as requested. - Documents utilization review decisions in computerized authorization management system. - Maintains professional licensure. - Engages in training as needed to stay informed of changes in best practice for supporting the needs of individuals with MH/SUD/IDD. Qualifications - Required: - Master’s degree in a Human Services field (such as Psychology, Social Work, or Counseling) and at least five years of post-degree progressive experience providing similar services to the population served (MH/SUD). - Current and active license issued by a North Carolina Professional Board, as a LCSW, LCAS, LP, LPA, LMFT, LCMHC, or RN. - A master's degree in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform this work; or graduation from a State accredited school of nursing and two years of experience in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform the work; or an equivalent combination of education and experience. - Preferred: - Experience in the public behavioral healthcare field is highly desired due to the complexity of the work. - Experience in a UM environment in Behavioral Healthcare would be valuable for this employee. Knowledge, Skills, & Abilities - Considerable knowledge of case management principles, practices, and applications. - Considerable knowledge of agency and community programs and services which affect clients and applicants. - Knowledge of state and federal client rights protection statutes and regulations applicable laws and regulations including but not limited to URAC, applicable Code of Federal Regulations, and NC Administrative Code. - Effective written and oral communication skills and interpersonal and presentation skills. - Ability to identify rights protection complaint issues; ability to set, monitor, and evaluate standards for quality and to assess plans to measure how they meet the needs of individual clients. - Considerable knowledge in DSM 5 diagnostic criteria. - Ability to manage time, prioritize work, and use problem-solving approaches. - Ability to coordinate effectively with staff from various agencies as well as inter-departmental. - Ability to read, analyze, and interpret regulations, policies, and procedures. - Ability to operate computer equipment and generate reports and records; ability to express ideas clearly and concisely orally and in written documents. - Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required. Salary Range $68,227 - $86,990/Annually. Exact compensation will be determined based on the candidate's education, experience, external market data, and consideration of internal equity. 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.

• Perform a full range of legal services in support of Alliance • Mitigate legal risk through practice in a variety of legal areas • Provide legal support in contracts including drafting and advising • Perform legal research and analysis, gather and analyze information • Represent Alliance in all stages of legal challenges • Communicate with external stakeholders and support consumer relations • Stay accessible to Alliance as needed

The Transition Coordinator II Supervisor provides oversight to Transition Coordinator, a team of licensed and non-licensed staff who provide or assist with the provision of Transitional Care Management for members with physical and/or behavioral health needs in Acute Care facilities, State Operated Developmental Centers, and Justice System settings. Our Transition Coordinator Supervisor may also provide oversight for Transition Coordinator staff dedicated to processing and conducting Warm Hand Offs to Provider Led Entities and other Plans. This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required. Responsibilities & Duties Supervise and Develop Staff - Work with Human Resources and Unit Director to maintain and retain a highly qualified and well-trained workforce - Ensure staff are well trained in and comply with all organization and department policies, procedures, business processes. and workflows - Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements - Actively establish and promote a positive, diverse, and inclusive working environment that builds trust - Ensure all staff are treated with respect and dignity - Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members - Work to resolve conflicts and disputes, ensuring that all participants are given a voice - Set goals for performance and deadlines in line with organization goals and vision - Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development - Cultivate and encourage efforts to expand cross-team collaboration and partnership Supervise Unit Operations - Participate in the initiation, development, and maintenance of clinical protocols and other population-based programs, facilitating collaboration and consensus of multidisciplinary teams as complete care is developed - Oversee the development of department specific goals and objectives ensuring alignment with system strategy, vision, mission, and values - Formulate, implement, and evaluate strategies for specialized staff education as it relates to member care, case management and plans of care Provide Customer Service - Develop strong working relationships with providers and internal/external stakeholders by scheduling ongoing opportunities to share feedback and collaborate - Exercise conflict resolution skills to appropriately resolve issues with providers and internal/external stakeholders - Develop strong working relationships among the department and provide customer services with providers and stakeholders internal/external by scheduling ongoing opportunities to share feedback and collaborate Quality/Data/Analytics - Review, validate and interpret risk stratification data and population health groups and recommends changes or adjustments to care management approach as needed - Utilize data systems to monitor process improvement and resource utilization - Knowledgeable of HEDIS measurements and population health within a complete care model - Utilize evidence-based practice to ensure quality outcomes for members Compliance with Alliance Policy and Procedure - Ensure adherence to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures Continuous Quality Improvement - Make recommendations to improve department procedures and increase operational efficiency - Monitor trends and identify opportunities for enhancements in service utilization and implementation throughout the organization Minimum Requirements Education & Experience Graduation from an accredited school of nursing with Registered Nurse license and five (5) years of experience with at least two (2) years of applicable experience with the population served, including experience with case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care Or Master’s degree in Human Services from an accredited college or university and three (3) years post graduate degree experience with at least two years of applicable experience with the population served, including experience with case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care. Must have a valid, active clinical license as a LCSW, LMFT, LCAS, LCMHC, LPA, or RN in North Carolina. Preferred: Two (2) years supervisory experience and CM or CCM certification preferred. Knowledge, Skills, & Abilities - Knowledge and understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and ICD-10 coding - Considerable knowledge of the MH/SUD/IDD service array provided through the network of the Applicant’s providers. - Knowledge in the implementation of the 1915 (b/c) waivers and national accreditation is essential. - Knowledge of and skilled in the use of MS Office Products including Outlook, Excel and Word - Detail-oriented and able to organize extensive amounts of clinical data, multiple tasks and priorities - Knowledge of research and best practice development in clinical practice, - Knowledge of Utilization Management/Utilization review and other related areas - Knowledge of Tailored Plan standards or procedures - Knowledge of the NC Division of Mental Health, Developmental Disabilities and - Substance Abuse IPRS Target Populations and Service Array - Knowledge of 1915(b) and NC Innovations Waiver - Knowledge of Medicaid and Innovations Service Array - Knowledge of applicable Federal laws, including Substance Abuse and HIPAA Privacy Laws. - Knowledge of National Accreditation standards and regulations - Ability to effectively manage projects from start to finish - Ability to adapt and shift focus according to mandated changes and changing priorities within the department. - Ability to access and interpret information and propose solutions to address issues and specific consumer needs and situations. - High level of diplomacy and discretion - Ability to effectively negotiate and resolve issues with minimal assistance. - Exceptional interpersonal skills - Ability to communicate effective orally and written - Ability to make prompt, independent decision based on relevant facts - Problem solving, negotiation, and conflict resolutions skills - Highly skilled at assuring that both long- and short-range goals and needs of the individual are addressed and updated, while also assuring through monitoring activities that service implementation is occurring appropriately. Employment for this position is contingent upon a satisfactory background and MVR (Motor Vehicle Registration) check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. Salary Range $77,868 - $99,282 Annually 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 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