Care Manager II (Full Time, Hybrid, North Carolina Based)

Requirements

• Complete comprehensive assessments at enrollment, yearly or at changes in condition.
• Develop Plans of Care derived from the completed assessments
• Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities
• Submit referral to the Integrated Health Consultant 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 evaluates appropriateness of services and ensures 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 care team, members supported, and service providers 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 trouble shoot until authorization is obtained. Notify providers of successful authorization
• Provide education and support to individuals and legally responsible persons 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 care settings and require assistance with returning to community-based services, to the Integrated Health Consultant
• Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management
• Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment
• Coordinate with other team members to ensure smooth transition to appropriate level of care.
• Attend treatment meeting with member, natural supports and selected providers.
• Schedule, coordinate and lead team conference calls on behalf of member needs
• Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment.
• Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.
• Verify that ongoing service adherence is maintained through monitoring.
• 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 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 Supervisor.
• Distribute surveys to members in service.
• 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 provides to all stakeholders involved.
• Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information
• Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care
• Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements
• 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

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