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Care Manager I-Non-Waiver

Location

United States

Posted

92 days ago

Salary

$29 - $38 / hour

Seniority

Lead

Job Description

Care Manager I-Non-Waiver

Alliance

Role Description The Care Manager I - 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-Waiver 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 I will collaborate with other community systems to work in partnership to support the identified population. This is a full-time remote opportunity. There is no expectation of coming into the office routinely; however, the selected candidate must be available to report onsite to the Alliance Office (Charlotte, North Carolina) for business meetings as needed. The successful candidate will also be required to travel weekly throughout Mecklenburg and surrounding counties (including ones outside of Alliance’s catchment area) to meet with members, providers, and/or other community stakeholders. Responsibilities & Duties - 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. - 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. - Submit required documentation to UM to ensure timely delivery of services and troubleshoot until authorization is obtained. - Provide initial contact with member for purpose of assessment and engagement. - Verify accuracy of demographic information with member and update inaccurate information from the Global Eligibility File following documented protocols. - Schedule face-to-face, virtual, and telephonic meetings 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. - 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. - Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures. - Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance-sponsored events, etc. may be required. - Travel to meet with members, providers, stakeholders, attend court hearings, etc. is required. Qualifications - 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. Requirements - 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. Benefits - Salary Range: $28.96 - $37.65/ Hourly. - Exact compensation will be determined based on the candidate's education, experience, external market data, and consideration of internal equity. - 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.

Job 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.
  • 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.

Benefits

  • Salary Range: $28.96 - $37.65/ Hourly.
  • Exact compensation will be determined based on the candidate's education, experience, external market data, and consideration of internal equity.
  • 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.

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