Care Manager I-TCL (Full-time Remote, North Carolina)

Alliance Health•Durham, NC

9d•$30 - $38•Remote

About The Position

The Care Manager I-TCL provides integrated, whole-person care management to individuals and families with special health care needs. The role coordinates physical health, behavioral health, pharmacy, and unmet health-related resource needs, connecting members with services and supports to improve outcomes and reduce unnecessary hospital and emergency service use. The position focuses on a specified population of members using health care services, ensuring their health needs and referrals are addressed, and collaborating with community systems to support members in remaining in their preferred housing in accordance with Transition to Community Living requirements. This is a full-time remote position with no routine expectation of reporting to an Alliance office. The selected candidate must be available to report onsite to the Morrisville, North Carolina office for business meetings as needed and may be required to travel regularly throughout Cumberland, Johnston, Harnett, Wake, and Durham counties to support member and business needs. Travel to meet members, providers, and stakeholders, attend court hearings, and participate in Alliance meetings and events is required. The Care Manager completes assessments and plans of care, supports and monitors members, maintains documentation and compliance, and coordinates transitions and services. The position also carries out Transition to Community Living monitoring and supports housing stability, rehousing, and housing separation activities.

Requirements

Bachelor’s degree from an accredited college or university in a Human Services field and two years of post-bachelor’s degree mh/dd/sa experience with the population served; or a bachelor’s degree in a non-Human Services field and four years of such experience; or a master’s degree in a Human Services field and one year of post-graduate mh/dd/sa experience with the population served.
Alternatively, be fully or provisionally licensed in North Carolina as an LCSW, LCMHC, LPA, or LMFT.
Alternatively, be a Licensed Registered Nurse (RN) in North Carolina with four years of mh/dd/sa experience with the population served.
Knowledge of person-centered thinking and planning and using assessments to develop plans of care.
Knowledge of the Diagnostic and Statistical Manual of Mental Disorders.
Knowledge of the LOC process, SIS for IDD, and FASN assessment for TBI.
Knowledge of Medicaid Tailored Plan, Medicaid Direct, enhanced MHSUD, and waiver benefits plans.
Knowledge of and skill in motivational interviewing.
Proficiency with Microsoft Office products such as Word, Excel, and Outlook.
Strong interpersonal, written, and verbal communication skills.
Conflict management and resolution skills.
Diplomacy and discretion to negotiate and resolve issues with minimal assistance.
Ability to make prompt, independent decisions based on relevant facts.
Satisfactory background and motor vehicle registration (MVR) checks after offer acceptance and before the start date.

Nice To Haves

NACCM certification.
NADD-Specialist certification.
CBIS certification.

Responsibilities

Complete comprehensive assessments or Care Needs Screenings at enrollment, annually, or when a member’s condition changes, and develop plans of care based on the assessments.
Apply whole-person and integrated care principles and assign care plan interventions to appropriate care management team members for monitoring and service engagement.
Refer members to the CCM when physical or behavioral health needs indicate medical or pharmaceutical complexity, and assign appropriate activities to Community Health Workers when social determinants of health, disparities, or complex payer issues are identified.
Assist individuals and legally responsible persons in choosing service providers objectively, evaluate service appropriateness, and ensure plans of care are implemented through information gathering and risk-based contact.
Use person-centered planning, motivational interviewing, and historical assessment information in JIVA to identify needed supports.
Collect data to identify barriers and assess the effectiveness of care management and care coordination in reducing lengths of stay and emergency service use.
Collaborate with members, legally responsible persons, care teams, providers, and identified supports to develop plans reflecting member needs and life goals, consistent with best practices and the permanent supportive housing model.
Schedule initial member contact and arrange face-to-face, virtual, and telephone meetings to provide information about the Alliance Health Plan, care teams, resources, and services.
Educate and support members and legally responsible persons regarding rights, grievances and appeals, service options, providers, and payer requirements.
Refer members in crisis or institutional settings who need help 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 the Quality Management Department.
Complete JIVA activities related to plans of care and coordinate with team members to support transitions to appropriate levels of care.
Check member status, verify care needs are met, update plans of care as needed, coordinate follow-up with stakeholders, and promote customer satisfaction through timely communication.
Verify ongoing service adherence through monitoring meetings with members, guardians, or providers; identify treatment barriers and assist with appointments and provider connections.
Maintain required member or legally responsible person contacts under state contractual requirements and attend community, provider, and stakeholder meetings as needed.
Obtain and upload supporting documents, legally responsible person verification, and releases of information; open JIVA episodes when needed and schedule initial contacts to verify demographics and build rapport.
Document member updates and activities, escalate complex or concerning cases to the immediate supervisor, and share appropriate documentation with stakeholders when consent is granted.
Maintain medical record compliance and quality in JIVA, Clive, and TCLD, and ensure clinical documentation meets state, agency, and Medicaid standards.
Respond proactively to planned moves outside the Alliance service area and other transition needs to avoid lapses in care.
Follow Alliance organizational policies, procedures, and Care Management Desk Procedures.
Complete Transition to Community Living monitoring to support tenancy, health, safety, community integration, property and provider coordination, technical assistance, service linkage, barrier resolution, monthly tenancy checklists, and routine reporting.
Assist the Post-Transition Engagement Specialist with contact information, as needed, for 11-month and 24-month Quality of Life surveys.
Support the Supportive Housing team in obtaining documents needed to maintain tenancy, including annual inspections, biannual recertification, income adjustments, and monthly housing checklists.
Complete and follow up on voucher applications, provide technical assistance to providers during rehousing, and follow up at least monthly with providers when a member loses TCL housing and requests rehousing.
Assist providers with required documents for members moving to the Bridge or Hotel Program, and update state and Alliance Health data systems when rehousing is confirmed.
Educate members about Individual Placement and Support-Supported Employment for employment referrals, community integration, and education referrals and support.
Complete required discharge tasks when a member leaves TCL housing.
Travel between Alliance offices, attend meetings and Alliance-sponsored events, meet with members, providers, and stakeholders, and attend court hearings as required.