Care Manager I-Waiver (Hybrid, North Carolina)

Alliance Health•Durham, NC

6d•$30 - $38•Hybrid

About The Position

The Care Manager I-Waiver provides integrated, whole-person, person-centered care management for individuals and families with special health care needs. The role coordinates physical health, behavioral health, pharmacy, and health-related resource needs to connect members with services and supports, maximize outcomes, and reduce unnecessary hospital and emergency-service use. The Care Manager focuses on an assigned population, addresses member health needs and referrals, and collaborates with community systems and other care team members. This is a full-time hybrid position with no routine office attendance expected. The selected candidate must be available to attend business meetings at the Alliance office as needed and travel weekly throughout the assigned county to meet with members, providers, and community stakeholders. Travel between Alliance offices and to meetings, events, court hearings, and other member-related activities may also be required. The Care Manager assesses member needs, develops and monitors plans of care and Individual Service Plans, coordinates referrals and service authorizations, supports members and legally responsible persons, and works with providers to address barriers and promote continuity of care. The role conducts required monitoring and documentation, supports transitions between levels of care or geographic areas, and follows applicable Alliance policies, state requirements, and Medicaid documentation standards. Candidates must meet one of the listed education, licensure, and experience pathways. A preferred qualification is NACCM, NADD-Specialist, and/or CBIS certification. The listed hourly salary range is $29.54–$38.40, with exact compensation based on education, experience, external market data, and internal equity. An excellent fringe benefit package is offered.

Requirements

Bachelor’s degree from an accredited college or university in a Human Services field and two years of post-bachelor’s mental health, developmental disabilities, and/or substance abuse experience with the population served, including two years of LTSS and/or HCBS coordination, care delivery monitoring, and care management experience; or an accepted alternative qualification pathway.
Alternatively, a bachelor’s degree in a non-Human Services field and four years of post-bachelor’s mental health, developmental disabilities, and/or substance abuse experience with the population served, including two years of LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
Alternatively, a master’s degree in a Human Services field and one year of post-graduate mental health, developmental disabilities, and/or substance abuse experience with the population served, including two years of LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
Alternatively, full or provisional licensure in North Carolina as an LCSW, LCMHC, LPA, or LMFT, plus two years of LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
Alternatively, an active North Carolina Registered Nurse license and four years of mental health, developmental disabilities, and/or substance abuse experience with the population served, including two years of LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
Knowledge of person-centered thinking and planning and using assessments to develop plans of care.
Knowledge of the Level of Care process, SIS for IDD, and FASN assessment for TBI.
Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefit plans.
Skill in motivational interviewing techniques.
Strong interpersonal, written, and verbal communication skills.
Conflict management and resolution skills.
Proficiency with Microsoft Office products such as Word, Excel, and Outlook.
Diplomacy and discretion to negotiate and resolve issues with minimal assistance.
Ability to make prompt, independent decisions based on relevant facts.
Availability to report onsite to the Alliance office for business meetings as needed and travel weekly throughout the assigned county.

Nice To Haves

NACCM certification.
NADD-Specialist certification.
CBIS certification.

Responsibilities

Complete comprehensive assessments or Care Needs Screenings at enrollment, annually, and when a member’s condition changes; complete required screening tools and review historical treatment data.
Develop plans of care from assessments, assign interventions and plan activities to appropriate care team members, and use person-centered planning and motivational interviewing to identify supports and goals.
Coordinate referrals for medical, pharmaceutical, behavioral health, social determinant, and other identified needs; assist members or legally responsible persons in choosing service providers objectively.
Evaluate service appropriateness and implementation through information gathering and contact based on risk stratification; collect data to identify barriers and assess care management effectiveness.
Collaborate with members, legally responsible persons, care teams, service providers, and other supports to develop plans reflecting member needs and life goals, including residential placement searches when needed.
Submit required documentation and service information to utilization management, troubleshoot authorization issues, notify care teams and providers of successful authorizations, and support applicable Medicaid C waiver enrollment and eligibility processes.
Schedule initial member contact and face-to-face, virtual, or telephone meetings; verify and update demographic information and educate members and guardians about the health plan, services, rights, grievances, appeals, provider options, and payer requirements.
Refer members in crisis or institutional settings who need help returning to community-based services to the appropriate consultant or care team member; recognize and report critical incidents and provider quality concerns.
Coordinate transitions to appropriate levels of care, maintain required member contacts, check on member status and needs, follow up with stakeholders, and promote customer satisfaction and service adherence.
Identify treatment barriers and help members arrange appointments or connect with treatment providers; attend community, provider, and stakeholder meetings as needed.
Coordinate and participate in SIS assessments, arrange assessments following specified facility discharges, and schedule and facilitate ISP meetings; develop and update ISPs.
Submit requests for services and purchase orders for products, supplies, and services covered under the Innovations waiver; complete required member or guardian check-ins.
Complete HCBS Notice of Change forms for applicable new provider placements and submit them to the Provider Network department; monitor service utilization and documentation against individualized goals and authorized service intent.
Respond proactively to planned moves outside the Alliance MCO geographic area and other transition needs to prevent interruptions in care.
Engage providers to identify and resolve member-level barriers to service delivery; ensure assessments, person-centered plans, discharge plans, and crisis plans are completed and shared with linked providers; report changes in member health status to authorized providers.
Conduct in-person, field-based service observations for Medicaid C services at required frequencies; for Non-Medicaid C services, complete Provider Engagement Tools and interventions to resolve administrative barriers.
Obtain, upload, and share supporting documentation, legally responsible person verification, releases of information, and service or doctor’s orders as applicable.
Open new episodes in JIVA when needed, document member updates and activities, escalate complex or concerning cases to the supervisor, maintain medical record compliance, distribute surveys, and ensure clinical documentation meets state, agency, and Medicaid standards.
Adhere to Alliance organizational policies, procedures, and Care Management Desk Procedures.
Travel to Alliance offices, meetings, events, member and provider visits, stakeholder activities, and court hearings as required.