Care Manager-Care Management for High-Risk Pregnancy (Hybrid, North Carolina)

Alliance Health•Fayetteville, NC

26d•$69,592 - $88,729•Hybrid

About The Position

The Care Management for High-Risk Pregnancy (CMHRP) Care Manager provides comprehensive, member-centered care management services to eligible high-risk pregnant members enrolled in Alliance Health’s CMHRP program. The role supports early identification, outreach, assessment, care planning, provider coordination, education, barrier resolution, social needs referrals, postpartum transition planning, and documentation in alignment with NCDHHS requirements and Alliance Health workflows. This is a full-time hybrid opportunity. Routine office attendance is not expected, but the selected candidate must be available to report onsite to the Alliance Office for business meetings as needed. Travel within Alliance communities throughout Cumberland County may be required. Travel to meet with members, providers, and stakeholders, attend court hearings, and attend Alliance meetings and events is required.

Requirements

Master’s degree from an accredited college or university in Human Services or a related field and at least two years of full-time, post-graduate-degree experience providing care management, case management, care coordination, discharge planning, or utilization management to members with behavioral and physical health conditions in a behavioral health, medical, or managed care setting; or graduation from a school of nursing, licensure as a Registered Nurse, and three years of full-time, post-degree experience.
For the master’s-degree pathway, must be fully or provisionally licensed in North Carolina as an LCSW, LMFT, LCAS, LCMHC, or LPA.
For the nursing pathway, must be licensed as a Registered Nurse in North Carolina.
Strong communication, engagement, documentation, organization, cultural responsiveness, problem-solving, and collaboration skills.
Ability to build trust with members, coordinate across providers and community partners, manage multiple priorities, recognize escalation needs, use care management technology, and follow standardized workflows while adapting support to individual member needs.
Must satisfy a background and Motor Vehicle Record check after accepting an offer and before the start date.

Nice To Haves

Experience in care management, maternal health, high-risk pregnancy support, Medicaid managed care, behavioral health, community health, or human services.
Knowledge of prenatal and postpartum care coordination, social drivers of health, behavioral health needs, community resources, and member engagement strategies.
Knowledge of the Tailored Plan and Medicaid Direct Transformation.
Knowledge of Tailored Plan standards or procedures.

Responsibilities

Support members identified for CMHRP during pregnancy and postpartum, as designed.
Provide, within scope, subject matter expertise regarding members’ physical and/or behavioral health to support a whole-person approach to care management.
Collaborate with Alliance staff, providers, primary care physicians, specialty care providers, community partners, and other stakeholders to support members in their home communities and address barriers.
Conduct timely outreach to members referred to or identified for CMHRP services using approved contact methods and engagement strategies.
Confirm eligibility, explain program services, support enrollment, document declinations or inability to contact, and notify appropriate providers when members enter the program.
Complete assessments of pregnancy-related risks, behavioral health needs, social drivers of health, barriers to prenatal care, member goals, and support needs.
Develop and maintain individualized, member-centered care plans with members, providers, and other supports as appropriate.
Provide education and care management support related to prenatal care engagement, warning signs, medication adherence, appointment follow-up, postpartum care, infant-related handoffs when applicable, and community resources.
Identify and help resolve barriers, including transportation, food insecurity, housing instability, language access needs, behavioral health needs, substance use concerns, interpersonal safety concerns, and other health-related social needs.
Escalate urgent maternal health concerns, behavioral health crisis needs, safety concerns, missed high-risk appointments, and unresolved access barriers according to approved workflows.
Coordinate with OB providers, Pregnancy Management Program providers, Advanced Medical Homes, hospitals, behavioral health providers, pharmacies, Local Health Departments, and community partners.
Participate in case reviews, supervision, quality audits, training, workflow refinement, and performance improvement activities.
Accurately and promptly document outreach, assessment findings, care plans, referrals, provider communications, escalation actions, and case closure activities in the designated care management platform.
Review, validate, and interpret patient identification and risk stratification data, and recommend adjustments to the care management approach as needed.
Use data to analyze member needs, guide staff training development, identify resource needs, and assess consistency of workflow implementation across disciplines.
Travel between Alliance offices; attend meetings and Alliance-sponsored events; and travel to meet with members, providers, and stakeholders and attend court hearings.