Care Manager I – Waiver

Job Description:

• Provide integrated, whole-person, person-centered care management for individuals and families with special health care needs
• Coordinate physical health, behavioral health, pharmacy, and unmet health-related resource needs
• Complete comprehensive assessments and care needs screenings
• Develop, assign, monitor, and update Plans of Care and Individual Service Plans
• Coordinate referrals, authorizations, services, providers, community systems, and internal care team members
• Support members and legally responsible persons with education, rights, grievances, appeals, service options, and payer requirements
• Schedule and conduct face-to-face, virtual, and telephonic member meetings
• Monitor service adherence, utilization, documentation, health status, progress, and individualized goals
• Identify treatment and service barriers and assist with appointments and provider linkage
• Coordinate SIS assessments, facility discharges, ISP meetings, waiver services, HCBS placements, purchase orders, and transitions
• Conduct required in-person field-based service observations for Medicaid C services
• Engage providers to resolve service-delivery and administrative barriers
• Obtain, upload, maintain, and share required documentation and releases
• Document member updates and activities in JIVA and maintain medical-record compliance
• Escalate complex cases and concerns to supervisors
• Report critical incidents, provider quality concerns, and changes in member health status
• Travel to offices, member homes, provider locations, stakeholder meetings, court hearings, and Alliance-sponsored events as required
• Ensure compliance with Alliance policies, procedures, state standards, and Medicaid requirements

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, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; OR
• Bachelor’s degree in a Non-Human Services field and four (4) years of post-bachelor’s degree mh/dd/sa experience with the population served, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; OR
• Master’s Degree in a Human Services field and one (1) year of post graduate degree mh/dd/sa experience with the population served, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; OR
• Fully or Provisionally Licensed in 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; OR
• Licensed Registered Nurse (RN) in North Carolina with four (4) years of mh/dd/sa experience with the population served, including two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience
• Preferred: NACCM, NADD-Specialist and/or CBIS Certification
• Knowledge of person-centered thinking/planning, assessments, plans of care, LOC process, SIS for IDD, FASN assessment for TBI, Medicaid benefits and waiver plans
• Skilled in Motivational Interviewing techniques
• Strong interpersonal and written/verbal communication skills
• Conflict management and resolution skills
• Proficient in Microsoft Office products, including Word, Excel, and Outlook
• High level of diplomacy and discretion
• Ability to make prompt, independent decisions based upon relevant facts
• Satisfactory background and MVR check after offer and before start date
• Required driver license

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