Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Care Management Medicaid Waiver Care Planning Care Coordination Care Planning Motivational Interviewing Escalation Procedures Service Accounts Information Management Metadata Standards Utilization Management Risk Analysis Assistive Technology Order Management Clinical Documentation Computerized Physician Order Entry Patient Education And Counseling Online Communication Conflict Management

Other Skills

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Microsoft Office
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Decision Making
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Communication
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Teamwork
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Mentorship
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Social Skills
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Diplomacy

Roles & Responsibilities

Bachelor’s degree in Human Services plus two years post-bachelor mh/dd/sa experience, including two years LTSS/HCBS coordination, care delivery monitoring, and care management.
Bachelor’s degree in a Non-Human Services field with four years post-bachelor mh/dd/sa experience, including two years LTSS/HCBS coordination and care management.
Master’s degree in Human Services with one year post-graduate mh/dd/sa experience, including two years LTSS/HCBS coordination and care management.
Fully or provisionally licensed in North Carolina as LCSW, LCMHC, LPA, or LMFT with two years LTSS/HCBS coordination; or licensed RN in North Carolina with four years mh/dd/sa experience including two years LTSS/HCBS coordination; Preferred: NACCM, NADD-Specialist and/or CBIS Certification.

Requirements:

Conduct and document assessments and planning for waiver members, including screening, home/vehicle modifications, AT/ATES, and ensure timely service delivery and authorization.
Provide education and support to members and legally responsible persons on waiver benefits, rights, grievance/appeals, and coordinate transitions across care levels.
Coordinate with providers to make referrals for waivers, residential placements, home modifications, and assistive technology; document updates and escalate complex cases as needed.
Ensure compliance and documentation quality, obtain necessary releases, maintain medical records, mentor new care managers, and adhere to Alliance policies.

Alliance Health

About Alliance Health

Alliance Health manages the public mental health, intellectual/ developmental disability, and substance abuse services for over 230,000 Medicaid-eligible citizens within a total population of 1.8 million in Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange, and Wake counties. Alliance's vision is to be a leader in North Carolina in transforming the delivery of whole-person care in the public sector. This vision guides us on our mission to improve the health and well-being of the people we serve by ensuring highly effective, community-based support and care. Further shaping our work are our core organizational values of accountability and integrity, collaboration, compassion, dignity and respect, and innovation. Alliance manages a diverse network of over 2300 private service providers and strives to ensure a dynamic, collegial workplace that provides opportunities for growth, success, and job satisfaction for its 800+ professional staff. Alliance has received full Health Network, Health Utilization Management, and Health Call Center accreditation from URAC.

Company type: SME

Founded: 2018

Company size: 1001 - 5000

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Job description

The Care Manager I Waiver Support will provide a range of care management and support functions to help ensure members on the Innovations and TBI waiver receive needed Home Modifications, vehicle modifications, Assistive Technology and Equipment (ATES) and service benefits available under these waivers. This support is provided to members receiving both internal Tailored Care Management and Tailored Care Management from Alliance Health’s Provider Lead Entities (PLE). Additionally, the position helps identify residential placements for waiver recipients and helps coordinate activities related to opening new waiver slots.

This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings may be required.

Responsibilities & Duties

Complete Assessment/Planning

Demonstrate commitment to whole person/integrated care
Complete required Screening Tools for members new to the waiver
Collects and reviews necessary assessments related to member need for home modifications, vehicle modification and other assistive technology
Gathers, organizes and may submit required documentation to UM related to home and vehicle modifications, assistive technology and education and training benefits available to waiver recipients
Ensure the timely delivery of services - and trouble shoot until authorization is obtained. Notify a member’s care team and providers of successful authorization

Provide Support and Monitoring to Members

Provides education about Alliance Health Plan, relevant waiver and available support, resources, and services to orient new members, and their legally responsible person, receiving slots about benefits of the Innovation and TBI waiver
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
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
Submit requests for services and purchase orders for products, supplies, and services covered under the Innovations waiver
Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email

Engage with Providers

Make service referrals for new waiver members, Residential placements, Home Modifications, and Assisted Technology and Supplies

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
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
Maintains medical record compliance/quality
Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements

Mentoring New Care Managers

Provide shadow opportunities for Risk assessment and Plan of Care development
Be available to assist with CC8P interpretive information in addition to explanations of benefits and services

Compliance with Alliance Policy and Procedure

Adheres to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

Minimum Requirements

Education & Experience

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. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.

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. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.

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. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.

Fully or Provisionally Licensed in the State of North Carolina as a LCSW, LCMHC, LPA, or LMFT and two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.

Licensed Registered Nurse (RN) in the State of North Carolina with four (4) years of mh/dd/sa experience with the population served. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.

Preferred: NACCM, NADD-Specialist and/or CBIS Certification

Knowledge, Skills, & Abilities

Person Centered Thinking/planning
Knowledge of using assessments to develop plans of care
Knowledge of LOC process, SIS for IDD and FASN assessment for TBI
Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans
Knowledge of and skilled in the use of Motivational Interviewing techniques
Strong interpersonal and written/verbal communication skills
Conflict management and resolution skills
Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
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

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

$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

An excellent fringe benefit package accompanies the salary, which includes: