Care Manager II (Hybrid, Smithfield, North Carolina Based)
Company: Alliance
Location: Smithfield
Posted on: May 27, 2023
Job Description:
We are currently seeking Care Managers to serve members in
Johnston county.
This position will allow the successful candidate the ability to
work remote certain days of the week. The employee will also be
required to come into the office closest to their home office
location on certain days as approved by their supervisor. This
position will require travel within the communities Alliance
serves.
The Care Manager II position leads all communication among care
team members and is the primary point of contact for the member
served. The Care Manager completes a comprehensive assessment and
develops a unified plan of care for Tailored Plan recipients and
relays communication among providers of health services.
Responsibilities & Duties
Complete Assessment/Planning
- 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 Support and
Monitoring
- Schedule initial contact with member to verify accuracy of
demographic information.
- Update inaccurate information from the Global Eligibility
File
- Schedule face to face meeting with member/LRP to provide
education about Alliance, Care Teams, 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 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 Minimum Education & Experience
Master's degree from an accredited college or university in Human
Services or related field and at least two years of full-time, post
graduate degree, MH/SUD and or Intellectual/Developmental
Disabilities (I/DD) experience and active, valid NC clinical
licensure as a LCSW, LCMHC, LPA, or LMFT
Or
Graduation from a school of nursing with valid NC licensure as a
Registered Nurse and two years of full-time MH/SUD and or
Intellectual/Developmental Disabilities (I/DD) experience.
Physical Health experience preferred
Special Requirements
Active Drivers License
RN, LCSW, LCMHC, LPA, or LMFT
Knowledge, Skills, & Abilities
- 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 basic, 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 Salary Range
$50,865.49 to $87,563.63/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
Keywords: Alliance, Raleigh , Care Manager II (Hybrid, Smithfield, North Carolina Based), Executive , Smithfield, North Carolina
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