Care Manager I-Non-Waiver (Hybrid, North Carolina Based)

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