[Hiring] Care Manager I-Waiver Support @Alliance Health

Role Description

The Care Manager I Waiver Support will provide a range of care management and support functions to help ensure members on the Innovations and TBI waiver receive needed Home Modifications, vehicle modifications, Assistive Technology and Equipment (ATES) and service benefits available under these waivers. This support is provided to members receiving both internal Tailored Care Management and Tailored Care Management from Alliance Health’s Provider Lead Entities (PLE). Additionally, the position helps identify residential placements for waiver recipients and helps coordinate activities related to opening new waiver slots. This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings may be required.

Responsibilities & Duties

• Complete Assessment/Planning
  • Demonstrate commitment to whole person/integrated care
  • Complete required Screening Tools for members new to the waiver
  • Collect and review necessary assessments related to member need for home modifications, vehicle modification and other assistive technology
  • Gather, organize and may submit required documentation to UM related to home and vehicle modifications, assistive technology and education and training benefits available to waiver recipients
  • Ensure the timely delivery of services - and troubleshoot until authorization is obtained. Notify a member’s care team and providers of successful authorization
• Provide Support and Monitoring to Members
  • Provide education about Alliance Health Plan, relevant waiver and available support, resources, and services to orient new members, and their legally responsible person, receiving slots about benefits of the Innovation and TBI waiver
  • Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance
  • Coordinate with other team members to ensure smooth transition to appropriate level of care when needed
  • Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment
  • Submit requests for services and purchase orders for products, supplies, and services covered under the Innovations waiver
  • Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email
• Engage with Providers
  • Make service referrals for new waiver members, Residential placements, Home Modifications, and Assisted Technology and Supplies
• Complete Documentation
  • Obtain and upload all supporting documentation, Legally Responsible Person (LRP) verification, and release of information that will improve care management activity on behalf of the member
  • Document all applicable member updates and activities per organizational procedure
  • Escalate complex cases and cases of concern to immediate supervisor
  • Ensure that service orders/doctor’s orders are obtained, as applicable
  • Share appropriate documentation with all involved stakeholders as consent to release is granted
  • Obtain releases/documentation and provide to all stakeholders involved
  • Maintain medical record compliance/quality
  • Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements
• Mentoring New Care Managers
  • Provide shadow opportunities for Risk assessment and Plan of Care development
  • Be available to assist with CC8P interpretive information in addition to explanations of benefits and services
• Compliance with Alliance Policy and Procedure
  • Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

Qualifications

• 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. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
• Or Bachelor’s degree from an accredited college or university in Non-Human Services field and four (4) years of post-bachelor’s degree mh/dd/sa experience with the population served. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
• Or Master’s Degree from an accredited college or university in Human Services field and one (1) year of post graduate degree mh/dd/sa experience with the population served. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
• Or Fully or Provisionally Licensed in the State of 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 the State of North Carolina with four (4) years of mh/dd/sa experience with the population served. Experience must include two (2) years LTSS and/or HCBS coordination, care delivery monitoring, and care management experience.
• Preferred: NACCM, NADD-Specialist and/or CBIS Certification

Knowledge, Skills, & Abilities

• Person Centered Thinking/planning
• Knowledge of using assessments to develop plans of care
• Knowledge of LOC process, SIS for IDD and FASN assessment for TBI
• Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans
• Knowledge of and skilled in the use of Motivational Interviewing techniques
• Strong interpersonal and written/verbal communication skills
• Conflict management and resolution skills
• Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
• High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
• Ability to make prompt, independent decisions based upon relevant facts

Requirements

• Employment for this position is contingent upon a satisfactory background and MVR (Motor Vehicle Registration) check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.

Salary Range

• $28.96 - $37.65/ Hourly
• Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity

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

Company Description

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