Tailored Care Management Director - Corporate

Pathways to Life•Greenville, NC

5d•Remote

About The Position

Pathways to Life is a certified Tailored Care Management provider serving NC Medicaid Tailored Plan members with behavioral health and substance use disorders, including members managing serious co-occurring physical health conditions. This is a corporate leadership role responsible for the entire Tailored Care Management program. The director will oversee the team, ensure compliance, maintain clinical quality, manage data, and build relationships with partners. The role requires regular travel across the service area to visit teams, host meetings, deliver training, and support the work happening on the ground. The company is growing and looking to fill this critical position quickly with the right candidate.

Requirements

Prior Tailored Care Management experience at the Supervising Care Manager level or above.
Minimum 5 years in behavioral health, care management, care coordination, or health care administration.
At least 3 years of supervising or leading experience.
Master's degree in Social Work, Counseling, Psychology, Public Health, Healthcare Administration, Nursing, or a closely related field. A bachelor's in a human services field with substantial leadership experience will be considered.
Working command of the NC Medicaid TCM Provider Manual, including supervisory ratios, qualification standards, assessment and care plan timeframes, qualifying contacts, and the six core Health Home services.
Direct experience with populations served: serious mental illness, serious and persistent mental illness, substance use disorder, and co-occurring physical health complexity.
Willingness and ability to travel regularly across the service area for site visits, team meetings, training, and partner engagements.
Valid NC driver's license, reliable transportation, current auto insurance.
Ability to pass criminal background and healthcare exclusion screening.

Nice To Haves

NC clinical licensure (LCSW, LCMHC, LMFT, LCAS, LPA, Licensed Psychologist, or RN).
Experience with Innovations or TBI waiver coordination, 1915(i) services, or Transition to Community Living.
Experience with certification reviews, Tailored Plan audits, or corrective action plans.
Comfort working with actual data files, not just dashboards.
Experience building a program from a small footprint into a durable service line.

Responsibilities

Accountable for the entire Tailored Care Management program, including the team (supervisors, care managers, extenders), hiring, training compliance, supervisory ratios, coverage during vacancy, and fostering a positive culture.
Ensure the compliance floor, including certification standards, Tailored Plan contract terms, documentation integrity, audit response, and corrective action.
Maintain clinical quality, including comprehensive assessments, Care Plans, multidisciplinary care teams, case conferences, transitional care, and access to clinical consultants.
Manage data, including beneficiary assignment files, claims and encounter data, acuity tiering, Patient Risk Lists, and quality measures, to inform program decisions and identify areas for improvement.
Build and maintain relationships with Tailored Plan and LME/MCO partners, primary care, hospitals, housing authorities, DSS, justice partners, and community organizations.