Alliance Health

The Claims Research Analyst position is critical for ensuring accurate, timely, and proactive communication to provider agencies related to claims submission, denial management, and system updates. The Claims Research Analyst position is critical for the reviewing, monitoring, and auditing claims and for educating the provider community to foster successful submission of claims. Claims Research Analysts research and analyze routine and complex claims data to determine that payments and settlements have been made in accordance with Alliance practices and procedures. Claims Research Analysts track trends and patterns, prepare data for monthly claims reports. This position is also a primary communication point for providers experiencing an array of claims difficulties. This position serves to provide excellent customer service to provider agencies. The Claims Research Analyst I responsibilities include (but are not limited to): Manage phone queue for general calls Review, key, process, status, track, and file Special Invoicing claims submissions Review patient and provider account updates in MCS and re-adjudicate claims as appropriate; including for retroactive Medicaid coverage, retroactive authorizations, provider contract updates, clinician credentialing updates Requirements Bachelor’s degree in related field and minimum of 1 year experience; or Graduation from high school plus two years minimum related experience. Knowledge and Skills Ability to set objectives and prioritize workflow Ability to document clearly and accurately Ability to solicit cooperation from persons and departments throughout the organization Ability to adhere to department policies, procedures, and general practices Knowledge of computer software including Excel, Word, Outlook Ability to work independently and as part of a team Excellent customer service skills Ability to demonstrate professional conduct in all situations Working knowledge of healthcare services and systems Working knowledge of functions provided by Provider Networks, Utilization Management, Accounts Payable, Contracts, Care Coordination in order to effectively identify claims needs and collaborate effectively with appropriate departments Knowledge of common claims denials and sources for correction Strong organizational skills Ability to solve complex problems through the evaluation of alternative methods and solutions Additional Training Preferred: Prior experience in a behavioral healthcare agency preferred. Salary Range $18.19 to $31.32/Hourly 

Alliance is seeking candidates for the role of Behavioral Health Crisis Clinician. The role is primarily responsible for conducting telephonic screening, triage and referral functions for individuals seeking services.  The Clinician ensures that individuals calling with service needs are safely linked in a timely fashion with available services and/or community resources.  The Clinician may also provide crisis service authorizations for both state and Medicaid funded emergency type services. This position will be equipped with all supplies and technologies to be able to work from home. The selected candidate must reside in North Carolina and is required to attend an initial 6 to 8- week virtual training period, Monday-Friday, between 9a.m. to 5p.m. Transition to permanent schedule to follow a successful training period. Some holiday hours are required. We are seeking to fill   two   positions to work one of the following schedules:   Sunday, Monday, Tuesday, Wednesday 8am- 6pm  Wednesday, Thursday, Friday, Saturday 8am-6pm Responsibilities & Duties Conduct Initial Screenings, Assessments, and Reviews, and make referrals Receive escalated calls from Member & Recipient Service Representatives who identified callers during initial screening that have urgent or emergent needs.  Callers may be actively psychotic, actively suicidal, actively homicidal, intoxicated, in active withdrawal and/or experiencing a medical emergency   Make clinical triage decisions based on often limited information obtained during telephonic screening Ensure individuals receive a comprehensive screening and appropriate referral that matches level of service needed Maintain safety of all callers, which may include contacting and mobilizing community first responders, (EMS, CIT officers, police, mobile crisis teams) Engage Decision to Warn when working with callers with active homicidal ideation, according to policy Report to Child Protective Services and Adult Protective Services, when warranted Identify high risk/special health care needs populations and refer to Care Coordination Review caller history, when available, in the client management system to help determine most appropriate referral option Use electronic scheduling system to schedule and secure assessment appointments with contracted providers based on consumer’s choice of service providers – considering consumer’s needs, location, and other provider characteristics Complete specialized screening documentation for all service-related calls; document all incoming call activity in MCO tracking system Simultaneously operate and navigate a multi-function phone system with multiple software programs while managing caller needs; serially operate and navigate multiple software programs in course of all duties Engage in follow-up activities to ensure consumers were seen for scheduled assessments and crisis follow-up appointments Route incoming calls to appropriate MCO departments when inquiries cannot be adequately addressed at the Call Center level Work independently to prioritize tasks and maintain idle status in call queue during high call volume and/or low staffing periods Simultaneous to other tasks, monitor incoming fax system and overflow vendor reports to ensure written referrals receive appropriate attention within expected time frames Provide Support, Consultation, & Leadership Interact with community emergency services orally while receiving information orally and in writing via IM Engage interpreter services when needed and adjust communication accordingly Provide oversight and clinical review of calls managed by overflow vendor Assist callers with addressing obstacles to accessing care and identify available resources Provide consultation and support to non-licensed Call Center staff Thoroughly train incoming staff to job duties and provide additional training to staff throughout clinical operations in the functions of the call center Compliance & Reporting Read, integrate, and adapt procedural tasks in a rapidly changing, paperless work environment Recognize and report quality concerns to supervisor and Provider Network Department Report patterns of atypical call and service-seeking patterns to supervisor   Minimum Requirements Education & Experience Master’s degree in Human Services field and minimum of three (3) years post degree experience in a community, business or governmental program that delivers mental health support services (e.g., adults with mental illness, children with severe emotional disturbance, and persons with developmental disabilities, adults, and children with substance abuse disorders) Special Requirements Requires individual to be Bilingual (clinically fluent) in Spanish and English.  Testing before hire will be required. Current, active, and unrestricted behavioral license issued by a North Carolina Professional Board, (LCSW, LCMHC, LCAS, LPA, LMFT) Knowledge, Skills, & Abilities Fluent in both Spanish and English for conversational and clinical language Knowledge of relevant state and federal laws (i.e., protection of client rights, mandatory reporting, and confidentiality). Knowledge of treatment modalities (i.e., Crisis Intervention, Motivational Interviewing, and Systems Theory). Knowledge of culturally competent practices. Knowledge of diagnostic and Statistical Manual of Mental disorders 5th edition. Thorough knowledge of the operation of MCO/LME structure within the North Carolina mental health system. Thorough knowledge of ASAM Criteria and resources in identified catchment area. Skill in the use of multiple software platforms and strong keyboarding skills to complete referral process. Skill troubleshooting minor technological issues independently. Considerable skill in identifying appropriate level of care based on information provided during time limited telephonic assessment. Ability to assess clinical level of need telephonically. Ability to multi-task and focus in a distracting environment. Ability to read, analyze, interpret, and implement regulations, policies, and procedures; transfer verbal information into written documentation, and the reverse; simultaneously incorporate written and oral information while speaking and typing. Ability to provide crisis response and deescalate difficult callers. Ability to coordinate effectively with staff from various agencies. Ability to manage time, problem solve, and prioritize work independently. Demonstrate flexibility and ability to work cohesively in a team. Ability to remain composed during high-stress, crisis-related calls. Ability to express ideas clearly and concisely orally and in written documents. Salary Range  $50,865.49 to $87,563.63/Annually 

The position is responsible for overseeing management of the Alliance project portfolio and tracking and reporting conformance to plans and expectations of various projects, as well as supporting and enabling the organization's cross-functional projects. This position will allow the successful candidate to work a Hybrid schedule, working three days remote certain days of the week as approved by their supervisor. Responsibilities & Duties Manage the Enterprise Project Portfolio Oversee the coordination and execution of projects and standardization of processes per the implementation of cross-functional initiatives Link the department goals and the Project Portfolio Management Office’s project activities to enable a consistent approach, standardized process, optimal resource management, and reliable tracking of project work. Facilitate an agreed-upon process that engages the stakeholders in the prioritization of projects and deliverables. Align action plan/task implementation and clearly defined success metrics, including milestone goals and timing with Business Evolution department strategy to ensure each initiative is on track Provide regular reports to Senior Vice President of Business Evolution on vital indicators related to project portfolio management targets by cross-functional projects, plus barriers and issues Continuously monitor project portfolio and provide reports to ensure Senior Vice President of Business Evolution is kept fully informed of resource capacity/demand and project portfolio status and issues Manage and Develop Staff Work with Human Resources and the SVP of Business Evolution to attract, maintain, and retain a highly qualified and well-trained workforce Lead the development of PPMO roles to deliver the agreed-upon PPMO goals and objective Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes Organize workflows and ensure staff understand their roles and responsibilities Ensure the team has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements Actively establish and promote a positive, diverse, and inclusive working environment that builds trust  Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members Work to resolve conflicts and disputes, ensuring that all participants are given a voice Set goals for performance and deadlines in line with organization goals and vision Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development Cultivate and encourage efforts to expand cross-team collaboration and partnership Consult with Internal Stakeholders Work closely with key leaders, to gain an understanding of each project’s goals, how the project is structured to succeed and apply this understanding to corresponding project action plans Build and maintain relationships with senior leadership and key PPMO stakeholders and advise leadership Manage Projects Ensure timely submission of project deliverables using the DHHS PCDU system Define, manage and direct end-to-end project management efforts Leverage best practices and techniques in identifying, quantifying and tracking progress against agreed-to milestones and deliverables Leads the identification and implementation of project management processes, methods, tools, guidelines and standards needed to establish a stable framework that supports all project teams and stakeholders to improve the probability of successful project delivery Deploys project management team resources to quickly drive process discipline, rigor and results throughout each strategic plan initiative Manages execution of complex projects that span multiple functional areas over an extended period of time, and in ongoing coordination with executive management   Minimum Requirements Education & Experience Bachelor’s degree in Project Management, Business Administration, Healthcare, or related field from an accredited college/university and at least five (5) years of experience leading and developing implementation of complex, enterprise-level, cross-functional projects and serving as the principal liaison to internal and external stakeholders. Two (2) years of leadership experience including indirect experience managing a team of matrixed individuals through common programs, projects, or related work efforts Preferred: Project Management experience in the Healthcare industry Special Requirement Project Management Professional (PMP) Certification Knowledge, Skills, & Abilities Demonstrated knowledge of and experience with Program planning, development, and implementation Demonstrated skills in effective oral and written communication Demonstrated Positive Leadership skills Ability to coordinate and direct employees and programs through an understanding of leadership skills, principles, techniques, and practices Ability to establish effective Internal/Work Group Relationships Knowledge of the Healthcare Industry preferred Ability to direct the establishment of division goals and priorities and determine appropriate resources preferred Ability to analyze data, make independent decisions based on analysis, and report outcome preferred Salary Range  $79,247.90to $136,423.21/Annually 

The Deputy Chief Medical Officer (DCMO) oversees and is responsible for supporting the Chief Medical Officer (CMO) in ensuring proper provision of services and ensuring an integrated approach to the physical and behavioral health of members and recipients, including those with I/DD and TBI needs. The Deputy Chief Medical Officer will apply evidence-based criteria in their oversight of physical health utilization management and care management. The DCMO will also manage some functions delegated by the CMO for clinical operation of Alliance Health. This position will offer a flexible schedule which will include the ability to work remote certain days of the week. The successful candidates must be a resident of North Carolina or willing to relocate. Responsibilities & Duties Provide Clinical Oversight to the organization Oversee proper provision of covered Medicaid and State-funded services to Members, as assigned by the Chief Medical Officer. Maintain efficient operations while ensuring attainment of quality of care and financial goals. Provide clinical leadership and oversight to the organization, including Utilization Management, Care Management, Access, Care Coordination, Network and Quality Management staff.   Oversee the development of evidence based clinical best practices, policies, and practices. Provide consultation to Alliance Management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and best practices.  Provide clinical supervision to clinical staff focusing on medical necessity, reason(s) for continued inpatient services, state requirements, appropriate medical practice and engagement, empowerment, recovery and rehabilitation. This responsibility includes peer review for utilization management and case escalation consultation for care management. Conduct analyses to identify service trends and patterns indicative of inappropriate, unreasonable, or medically unnecessary care. Oversee clinical data analytics, including helping train staff and providers on understanding on how to analyze and use data and information.  Help develop key clinical indicators including structural, process and outcomes measures. Use data to identify opportunities for improvement and implementing strong action plans. Supports the organization to ensure an integrated approach to the physical and behavioral health of members and recipients, including those with I/DD and TBI needs. Oversee appropriate utilization by ensuring peer reviews and determinations meet clinical criteria and guidelines. Conduct clinical reviews of contracted provider clinical records as requested.   Develop Clinical practice standards Develop Clinical Practice standards for Medicaid Managed Care Program and State-funded services. Establishing and implement standards and policies to ensure the quality of the medical care provided to patients Responsible for implementing a recovery philosophy, maintaining a knowledge base in rehabilitation and recovery principles and innovations; modeling principles of engagement, empowerment and learning with colleagues and employees, and training all staff in the practical implications of these principles with a particular emphasis on care management, alternative levels of care and network sufficiency. Manage and develop staff Responsible for establishing and implementing a safe working environment that meets all licensure, regulatory, and accreditation requirements. Work with Human Resources and CMO to maintain highly qualified and well trained staff.   Provide in service training for staff on managed care and general clinical issues including helping staff to understand direct service vs. care management in a managed care environment., Monitor and manage staff productivity. Ensure staff are well trained in Alliance policies, procedures, and business processes. Ensure the department has the needed tools to fulfill functions and support employees Provides ongoing coaching and mentoring to staff and support a learning environment to advance team skills Develop and Implement Clinical Policies and Procedures Support the maintenance of evidence-based clinical protocols and policies to enhance the quality of medical necessity decision-making.  In consultation with the Chief Medical Officer establish criteria and procedures for review of clinical cases. Develop and Implement Clinical Policies and Procedures Responsible for medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews, and clinical best practices guideline development. Collaborate and Provide Consultation Participates in the development of Alliance’s benefit plan for Medicaid members and state-funded recipients. Provide advice and counsel to Executive leadership on medical and administrative matters. Participate in committees that support organizational goals and best clinical practice including internally-facing groups and provider or member-facing groups. Works with executive and senior management to establish goals and needs for Clinical Operations. Partner closely with all stakeholders to develop and implement initiative task plans that enable optimal outcome in regards to improved patient outcomes and member access, quality and satisfaction. Participate in building coalitions internally and with other federal, state, and local governments, nonprofit and private sector organizations. Provide consultation to providers and other community-based clinicians, including general practitioners. May consult with and act as a liaison with area facilities, physicians, and agencies as requested. Ensure compliance with applicable regulatory and accreditation requirements. Minimum Requirements Psychiatrist fully licensed to practice in North Carolina and in good standing with a minimum of five (5) years’ experience in a BH and/or I/DD clinical setting and two (2) years’ experience in managed care. Clinical experience with child mental health or addition/SUD preferred. Must reside in North Carolina or be willing to relocate. Knowledge, Skills, and Abilities Thorough knowledge of the theory, principles, and practices of general, preventive, and applicable specialty medicine and of the techniques involved. Thorough knowledge of the developments in the field of medicine. Considerable knowledge of stat, organizational, and medical rules and regulations. Thorough knowledge of biological, social and psychological development process of patients served. Thorough knowledge of techniques of interviewing and counseling, assessment and evaluation of medical histories and presenting problems, principles and practices of medicine, appraisal tools, laboratory tests and findings, and knowledge of how to plan and carry out a regimen of care and treatment General knowledge of planning, budgeting and policy making processes. Knowledge of cultural awareness and differences, and the ability and sensitivity to work with and/or serve a diverse population. Skill in leadership, teaching and management techniques. Ability to lead interdisciplinary teams. Ability to compile clear and concise notes for patient’s charts and to make oral presentations of cases in medical conference. Ability to guide work performance of physicians with limited experience. Ability to establish and maintain effective working relationships with associate personnel, consumers, and their families and the general public. Excellent skills in the medical assessment/ evaluation. Ability to record accurately and completely all information necessary to evaluate and plan care and treatment. Ability to communicate information accurately Ability to speak with colleagues about treatment concerns and/or recommendations. Required License Active, unencumbered NC Medical license Salary Requirement  $223,000.06 to $383,888.82/Annually  Salary offer will be commensurate with experience. An excellent fringe benefit package accompanies the salary, which includes:  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

Description We are currently seeking a Supervisor II-Integrated Health Consultants to serve members in Mecklenburg county.  The Integrated Health Consultant Supervisor II provides oversight to Integrated Health Consultants, a team of licensed and non-licensed staff who provide team-based care to members transitioning from acute care, institutional care or the justice system to community-based care, or who address barriers that impede improved community tenure, with the support of network providers and community social service agencies. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work 4 days of the week as approved by their supervisor. Responsibilities & Duties Supervise and Develop Staff  Work with Human Resources and Unit Director to maintain and retain a highly qualified and well-trained workforce  Ensure staff are well trained in and comply with all organization and department policies, procedures, business processes.  and workflows Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements Actively establish and promote a positive, diverse, and inclusive working environment that builds trust  Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members Work to resolve conflicts and disputes, ensuring that all participants are given a voice Set goals for performance and deadlines in line with organization goals and vision Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development Cultivate and encourage efforts to expand cross-team collaboration and partnership Operations Participate in the initiation, development, and maintenance of clinical protocols and other population-based programs, facilitating collaboration and consensus of multidisciplinary teams as complete care is developed Oversee the development of department specific goals and objectives ensuring alignment with system strategy, vision, mission, and values Formulate, implement, and evaluate strategies for specialized staff education as it relates to member care, case management and plans of care Develop strong working relationships with providers and internal/external stakeholders by scheduling ongoing opportunities to share feedback and collaborate Exercise conflict resolution skills to appropriately resolve issues with providers and internal/external stakeholders Develop strong working relationships among the department and provide customer services with providers and stakeholders internal/external by scheduling ongoing opportunities to share feedback and collaborate Customer Service Develop strong working relationships with providers and internal/external stakeholders by scheduling ongoing opportunities to share feedback and collaborate Exercise conflict resolution skills to appropriately resolve issues with providers and internal/external stakeholders Develop strong working relationships among the department and provide customer services with providers and stakeholders internal/external by scheduling ongoing opportunities to share feedback and collaborate Quality/Data/Analytics Review, validate and interpret risk stratification data and population health groups and recommends changes or adjustments to care management approach as needed Utilize data systems to monitor process improvement and resource utilization  Knowledgeable of HEDIS measurements and population health within a complete care model Utilize evidence-based practice to ensure quality outcomes for members Compliance with Alliance Policy and Procedure Ensure adherence to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures Continuous Quality Improvement Make recommendations to improve department procedures and increase operational efficiency Monitor trends and identify opportunities for enhancements in service utilization and implementation throughout the organization Knowledge, Skills, & Abilities Knowledge and understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and ICD-10 coding Considerable knowledge of the MH/SUD/IDD service array provided through the network of the Applicant’s providers.  Knowledge in the implementation of the 1915 (b/c) waivers and national accreditation is essential.   Knowledge of and skilled in the use of MS Office Products including Outlook, Excel and Word Detail-oriented and able to organize extensive amounts of clinical data, multiple tasks and priorities Knowledge of research and best practice development in clinical practice,  Knowledge of Utilization Management/Utilization review and other related areas Knowledge of Tailored Plan standards or procedures Knowledge of the NC Division of Mental Health, Developmental Disabilities and  Substance Abuse IPRS Target Populations and Service Array Knowledge of 1915(b) and NC Innovations Waiver Knowledge of Medicaid and Innovations Service Array Knowledge of applicable Federal laws, including Substance Abuse and HIPAA Privacy Laws. Knowledge of National Accreditation standards and regulations Ability to effectively manage projects from start to finish Ability to adapt and shift focus according to mandated changes and changing priorities within the department.   Ability to access and interpret information and propose solutions to address issues and specific consumer needs and situations.   High level of diplomacy and discretion Ability to effectively negotiate and resolve issues with minimal assistance. Exceptional interpersonal skills Ability to communicate effective orally and written Ability to make prompt, independent decision based on relevant facts Problem solving, negotiation, and conflict resolutions skills Highly skilled at assuring that both long- and short-range goals and needs of the individual are addressed and updated, while also assuring through monitoring activities that service implementation is occurring appropriately. Minimum Education & Experience requirements Master’s degree in Human Services and five (5) years post graduate degree experience with at least two years of applicable experience with the population served, including experience with case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care.   Or Graduation from an accredited nursing school and five (5) years of experience with at least two years of applicable experience with the population served, including experience with case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care Physical health experience highly preferred.  Accredited Case Manager (ACM)   or   Certified Case Manager (CCM) credentials preferred. Special Requirements- Active NC Driver’s license Active Clinical License ( LCSW, LCMHC, LPA, LMFT or RN) Salary Range $65,073.41  to $ 112,022.19

We are currently seeking Care Managers to serve members in Johnston county. This position will allow the successful candidate to work a primarily remote schedule which includes coming into the Alliance Johnston office (Smithfield, North Carolina) one day per week. The Care Manager II position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues Assist individuals/legally responsible persons in choosing service providers; ensuring objectivity in the process Consistently evaluates appropriateness of services and ensures implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification Utilize person centered planning, motivational interviewing and historical review of assessments in Jiva to gather information and to identify supports needed for the individual Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services and trouble shoot until authorization is obtained.  Notify providers of successful authorization Provide Support and Monitoring Schedule initial contact with member to verify accuracy of demographic information.  Update inaccurate information from the Global Eligibility File Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services  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. Refer members who are in crisis/institutional care settings and require assistance with returning to community-based services, to the Integrated Health Consultant Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment Coordinate with other team members to ensure smooth transition to appropriate level of care. Attend treatment meeting with member, natural supports and selected providers.    Schedule, coordinate and lead team conference calls on behalf of member needs Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.  Verify that ongoing service adherence is maintained through monitoring.  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 Open new episodes in JIVA and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Escalate complex cases and cases of concern to Supervisor. Distribute surveys to members in service. 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 provides to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements Minimum Education & Experience Master’s degree from an accredited college or university in Human Services or related field and at least two years of full-time, post graduate degree, MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active, valid NC clinical licensure as a LCSW, LCMHC, LPA,  or LMFT Or Graduation from a school of nursing with valid NC licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience. Physical Health experience preferred Special Requirements Active Drivers License RN, LCSW, LCMHC, LPA,  or LMFT Knowledge, Skills, & Abilities Person Centered Thinking/planning Knowledge of using assessments to develop plans of care Knowledge of Diagnostic and Statistical Manual of Mental Disorders 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 Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.) Strong interpersonal and written/verbal communication skills essential, including  Conflict management and resolution skills 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 Salary $50,865.49  to $ 87,563.63/Annually

Description We are currently seeking Care Managers to serve members in Mecklenburg or Wake county.      This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. The Care Manager II position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues Assist individuals/legally responsible persons in choosing service providers; ensuring objectivity in the process Consistently evaluates appropriateness of services and ensures implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification Utilize person centered planning, motivational interviewing and historical review of assessments in Jiva to gather information and to identify supports needed for the individual Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services and trouble shoot until authorization is obtained.  Notify providers of successful authorization Provide Support and Monitoring Schedule initial contact with member to verify accuracy of demographic information.  Update inaccurate information from the Global Eligibility File Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services  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. Refer members who are in crisis/institutional care settings and require assistance with returning to community-based services, to the Integrated Health Consultant Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment Coordinate with other team members to ensure smooth transition to appropriate level of care. Attend treatment meeting with member, natural supports and selected providers.    Schedule, coordinate and lead team conference calls on behalf of member needs Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.  Verify that ongoing service adherence is maintained through monitoring.  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 Open new episodes in JIVA and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Escalate complex cases and cases of concern to Supervisor. Distribute surveys to members in service. 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 provides to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements Minimum Education & Experience Master’s degree from an accredited college or university in Human Services or related field and at least two years of full-time, post graduate degree, MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active, valid NC clinical licensure as a LCSW, LCMHC, LPA,  or LMFT Or Graduation from a school of nursing with valid NC licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience. Physical Health experience preferred Special Requirements Active Drivers License RN, LCSW, LCMHC, LPA,  or LMFT $50,865.49  to $ 87,563.63/Annually

We are currently seeking Care Managers to serve members in Wake county.    This position will allow the successful candidate to work a primarily remote schedule which includes coming into the Alliance Home office (Morrisville, North Carolina) at least one day per week. Minimum Education & Experience Master’s degree from an accredited college or university in Human Services or related field and at least two years of full-time, post graduate degree, MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active, valid NC clinical licensure as a LCSW, LCMHC, LPA,  or LMFT Or Graduation from a school of nursing with valid NC licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience. Physical Health experience preferred Special Requirements Active Drivers License RN, LCSW, LCMHC, LPA,  or LMFT

We are currently seeking Care Managers to serve members in Mecklenburg county.      The Care Manager I position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments. Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities.  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity.  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals/legally responsible persons (LRP in choosing service providers; ensuring objectivity in the process. Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification.  Utilize person centered planning, motivational interviewing and historical review of assessments to gather information and to identify supports needed for the individual. Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services - and trouble shoots until authorization is obtained.  Notifies providers of successful authorization. Notify providers of successful authorization. For Medicaid C, enlists administrative support to send Level of Care (LOC) and initial Individual Service Plan (ISP) to Department of Social Services (DSS) to turn on special waiver program indicator.  Verify that necessary Client, Employer, Group (CEG) enrollments are correct in Jiva, and that Medicaid eligibility is updated in Alpha. Provide Support and Monitoring to Members Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information from the Global Eligibility File. Completes activities related to Plans of Care  Coordinate and participate with SIS Team to ensure successful completion of SIS assessment within time frames allotted.   For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.  Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan. Schedule and facilitate the ISP meeting. Develop and update ISP  Submit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver. Coordinate with other team members to ensure smooth transition to appropriate level of care.  Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.  Complete Home and Community Based Services (HCBS) Notice of Change Form when arranging new HCBS service placement (for Residential Supports, Day Supports, and Supported Employment) with a new provider and submit to Provider Network department to ensure successful transition to provider. Refer provider contractual concerns to Provider Networks. Update other Care Team members of urgent or pertinent treatment updates  Recognize and report critical incidents to supervisors and Quality Management.  Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services.  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. Escalate complex cases and cases of concern to Supervisor. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.   Verify ongoing service adherence with member and/or guardian Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care. Complete Documentation  Open new episodes in Jiva and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Obtain releases/documentation and provide to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements. Minimum Education & Experience Bachelor’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and two (2) years of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI) OR Master’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and one (1) year of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI), OR Graduation from an accredited Nursing program and licensure as a Registered Nurse 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 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 Salary $22.15  to $ 38.14/Hourly

We are currently seeking Care Managers to serve members in Cumberland county.     The Care Manager I position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments. Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities.  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity.  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals/legally responsible persons (LRP in choosing service providers; ensuring objectivity in the process. Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification.  Utilize person centered planning, motivational interviewing and historical review of assessments to gather information and to identify supports needed for the individual. Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services - and trouble shoots until authorization is obtained.  Notifies providers of successful authorization. Notify providers of successful authorization. For Medicaid C, enlists administrative support to send Level of Care (LOC) and initial Individual Service Plan (ISP) to Department of Social Services (DSS) to turn on special waiver program indicator.  Verify that necessary Client, Employer, Group (CEG) enrollments are correct in Jiva, and that Medicaid eligibility is updated in Alpha. Provide Support and Monitoring to Members Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information from the Global Eligibility File. Completes activities related to Plans of Care  Coordinate and participate with SIS Team to ensure successful completion of SIS assessment within time frames allotted.   For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.  Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan. Schedule and facilitate the ISP meeting. Develop and update ISP  Submit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver. Coordinate with other team members to ensure smooth transition to appropriate level of care.  Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.  Complete Home and Community Based Services (HCBS) Notice of Change Form when arranging new HCBS service placement (for Residential Supports, Day Supports, and Supported Employment) with a new provider and submit to Provider Network department to ensure successful transition to provider. Refer provider contractual concerns to Provider Networks. Update other Care Team members of urgent or pertinent treatment updates  Recognize and report critical incidents to supervisors and Quality Management.  Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services.  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. Escalate complex cases and cases of concern to Supervisor. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.   Verify ongoing service adherence with member and/or guardian Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care. Complete Documentation  Open new episodes in Jiva and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Obtain releases/documentation and provide to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements. Minimum Education & Experience Bachelor’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area with (2) years of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI) OR Master’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and one (1) year of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI), OR Graduation from an accredited Nursing program and licensure as a Registered Nurse 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 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 Salary $22.15  to $ 38.14/Hourly

We are currently seeking Care Managers to serve members in Durham, Johnston, Cumberland and Wake counties.     The Care Manager I position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments. Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities.  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity.  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals/legally responsible persons (LRP in choosing service providers; ensuring objectivity in the process. Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification.  Utilize person centered planning, motivational interviewing and historical review of assessments to gather information and to identify supports needed for the individual. Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services - and trouble shoots until authorization is obtained.  Notifies providers of successful authorization. Notify providers of successful authorization. For Medicaid C, enlists administrative support to send Level of Care (LOC) and initial Individual Service Plan (ISP) to Department of Social Services (DSS) to turn on special waiver program indicator.  Verify that necessary Client, Employer, Group (CEG) enrollments are correct in Jiva, and that Medicaid eligibility is updated in Alpha. Provide Support and Monitoring to Members Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information from the Global Eligibility File. Completes activities related to Plans of Care  Coordinate and participate with SIS Team to ensure successful completion of SIS assessment within time frames allotted.   For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.  Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan. Schedule and facilitate the ISP meeting. Develop and update ISP  Submit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver. Coordinate with other team members to ensure smooth transition to appropriate level of care.  Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.  Complete Home and Community Based Services (HCBS) Notice of Change Form when arranging new HCBS service placement (for Residential Supports, Day Supports, and Supported Employment) with a new provider and submit to Provider Network department to ensure successful transition to provider. Refer provider contractual concerns to Provider Networks. Update other Care Team members of urgent or pertinent treatment updates  Recognize and report critical incidents to supervisors and Quality Management.  Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services.  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. Escalate complex cases and cases of concern to Supervisor. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.   Verify ongoing service adherence with member and/or guardian Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care. Complete Documentation  Open new episodes in Jiva and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Obtain releases/documentation and provide to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements. Minimum Education & Experience Bachelor’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area with (2) years of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI) OR Master’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and one (1) year of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI), OR Graduation from an accredited Nursing program and licensure as a Registered Nurse 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 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 Salary $22.15  to $ 38.14/Hourly

We are seeking a Director of Child & Adult Welfare to serve Mecklenburg or Wake county members. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work 4 days of the week as approved by their supervisor. The Director of Child & Adult Welfare oversees clinical care management for children in foster care or other out of home placement, children involved with Juvenile Justice, and adults in the guardianship of a county department of social/human services. The Director is responsible for ensuring this population receives quality healthcare to meet their overall need by providing oversight to care management staff and supervisors for complex cases within the domains of this defined population. The position oversees the entire Alliance Health catchment area.   The Director aligns clinical innovation of new and existing service lines to meet or exceed health outcomes and financial goals through coordination with other departments including Utilization Management, Provider Networks, Quality Management and Finance.         Responsibilities & Duties System oversight Ensure health care services are being delivered in a manner that is sensitive to the child’s or adult’s needs Provide oversight and monitor the health care outcomes of all children in out-of-home placement and adults with guardians Participate in complex case consultation as needed Provide necessary recommendations to staff members to ensure children in out of home placement and adults with guardians receive ongoing follow-up care with appropriate primary and specialty services Recommend changes or adjustments to care management approaches as needed Monitor and Ensure all federal EPSDT examination schedule and guidelines for all children in placement are received System development Utilize data to analyze needs of the members, guide staff training development, identify resource needs and consistency of workflow implementation across disciplines\ Ensure integration of health care planning into the permanency planning with DSS Establish standardized methodologies to support development and direct management of the new and existing services Assist with the development of policies and workflows to support implementation of new and/or enhanced care management solutions Create and communicate detailed business requirements to support appropriate system development Provide guidance on implementation, communication and updates of systems and processes to promote and facilitate continuous quality improvement activities Collaboration and Communication with Community and internal stakeholders Communicate regularly to stakeholders on the status of current solution development and implementation activities Build relationships and tangible partnerships between state agencies, providers, children and their family teams, and adults and their guardians Collaborate with the Department of Social Services (DSS) to meet the health care and protection needs of children in out-of-home placement, as well as adults with adults with guardians. Collaborate with the Director of Foster Care Support to ensure a cohesive strategy with DSS Staff Management and Development Work with Human Resources to maintain and retain a highly qualified and well-trained workforce.   Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes. Organize workflows and ensure staff understand their roles and responsibilities. Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements. Actively establish and promote a positive, diverse, and inclusive working environment that builds trust.  Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members. Work to resolve conflicts and disputes, ensuring that all participants are given a voice. Set goals for performance and deadlines in line with organization goals and vision. Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development. Cultivate and encourage efforts to expand cross-team collaboration and partnership.   Minimum Requirements Master’s degree in a human services field from an appropriately accredited institution and five (5) years of experience in the area of assignment, including two (2) years in a supervisory of consultative capacity Special Requirements Current licensure in a clinical discipline including LCSW, LCMHC, or LMFT Valid Driver License   Knowledge, Skills, & Abilities Knowledge of and experience working with local Divisions of Social Services, government sponsored programs, health plan, provider/ACO groups Knowledge of population health, care management and healthcare consumerism, and governing guidelines such as HIPAA, Legal and Regulatory Requirements. Knowledge of community resources, partnerships and access to child programs/service Knowledge of principles, methods, and techniques of efficient administration, including public relations, personnel administration, budgeting, accounting, and office management. Knowledge of social, medical, and economic factors of the community. Excellent skill in communicating, both verbally and in writing. Proficiency in MS Office (Word, Excel, PowerPoint, & Outlook), Experience with Project Management and other relevant office tools, including MS-Project & Visio Perseverance to constantly enhance, track performance, and improve results along with demonstrated clinical outcomes. Excellent documentation skills with emphasis on defining business and functional requirements Ability to interpret and apply laws and policies to specific problems relating to agency activities. Ability to establish and maintain effective working relationships with agency personnel, county officials, and the public.   Salary Range   $75,438.27 to $129,865.03  

Submit Application and Resume to Alliance Health at  https://www.alliancehealthplan.org Reference Requisition HEALT001797  Morrisville The Health Literacy  Project Manager assists efforts to improve organizational health literacy.   The Health Literacy Project Manager will manage the development, implementation, and quality evaluation of health literacy and assist in the development and implementation of quality improvement initiatives related to cultural competence, health literacy, inclusion, and health equity. This position will allow the successful candidate to work a primarily remote schedule which includes coming into the Alliance Home office (Morrisville, North Carolina) one to two days per week.  Responsibilities & Duties Develop and evaluate health information and related communications Facilitate plain language translation projects Ensure all state required communications to members are developed to meet the health literacy levels of our members Review health information to ensure that it is understandable and actionable [e.g., using Suitability Assessment of Materials (SAM), PE-MAT, CDC Clear Communication Index]. Assist in the development, implementation and evaluation of quality improvement initiatives related to health literacy Design digital and printed materials that convey health information in a compelling, easy-to-understand way and distribute the materials to the public Develop public service announcements and similar ad campaigns regarding health issues Identify and address the intended audience’s characteristics, needs, and interests when communicating health information Assess past and current public messaging to evaluate its effectiveness and then use the findings to develop more effective campaigns Assist with efforts to implement best practices in Health Literacy across the organization Review current literature and health care developments to develop evidence-based quality improvement initiatives; benchmark other organizations and industries to identify applicable best practice Evaluate public health risks and trends to identify priorities Identify key areas for health literacy improvement to build a health literate organization Engage employees across the organization, providers, stakeholders, advocates, and members in health literacy improvements efforts.  Plan, develop, implement, and evaluate quality improvement initiatives related to health literacy Report on key evaluation findings to employees,  board members,  stakeholders, advocates, and members Conduct ongoing documentation, monitoring, and evaluation of health literacy projects Evaluate policies, procedures, and manuals to ensure health literacy is incorporated Evaluate health literacy in emergency preparedness, crisis and emergency response, and business continuity Train employees and stakeholders on Health Literacy Develop teaching tools to promote health literacy across the organization Deliver health literacy trainings for staff Develop community health education programs and materials Host workshops with members of the public to educate them about chronic disease management or preventive health choices Engage Leadership in Health Literacy improvement Provide consultation to organization leadership on incorporating health literacy into strategic and operational planning and quality improvement Provide tools for leadership to integrate health literacy throughout the organization Minimum Requirements Education & Experience Bachelor’s degree in Communications, Health Communications, Human Services, or related field and six (6) years of experience in health care communications. Preferred Education and Experience Degree in Health Communications Experience in health literacy implementation, diversity, inclusion, and equity, and/or medical knowledge, and experience with Medicaid  Experience collaborating with community and Tribal health partners Knowledge, Skills, & Abilities Knowledge of project management, organizational process, change management and quality improvement processes. Knowledge of Healthcare and Health Literacy Excellent verbal and written communication skills. Excellent organizational skills. Skilled at using a variety of website applications. Demonstrated Facilitation skills Demonstrated skill in providing trainings to various audiences Ability to design, implement, and manage multiple high priority projects in a complex healthcare environment with tight deadlines. Ability to build trusted relationships Ability to pursue opportunities to learn, research, publish and present information on health literacy, quality and safety, community health, health disparities, and inclusion Ability to translate broad organizational strategies into clear objectives and practical action plans. Ability to work independently and interactively at all levels of the organization. Salary Range $68,359.62 to $117,679.31/Annually

Submit Application and Resume to Alliance Health at  https://www.alliancehealthplan.org Reference Requisition INFOR001785 The Software Quality Engineer assists in managing the quality control function (assists in establishing, overseeing, and coordinating quality control policy and practice) of the organization software applications. Responsible for continuously reviewing quality assurance philosophy, practices, and procedures to ensure the highest standards. Develops, coordinates and conducts technical reliability studies and evaluations of software quality engineering design concepts. Recommends design or test methods and statistical process control procedures for achieving required levels of product reliability. Assists in managing the Agile testing of all reporting and application quality, ensuring compliance with company standards and applicable government regulations. Recommends corrective action where necessary, develops quality control manuals, and participates in the development of new methods, procedures, and systems.   May serve as a specialist in the areas of design, product evaluation and reliability, and research and development as they applied to quality engineering.  May oversee configuration management processes for assigned programs and support Build Readiness Reviews, Build Process or similar processes. May perform lead duties as specified by their supervisor. This position will allow the successful candidate to work a schedule which will include both onsite as well as remote work certain days of the week as approved by their supervisor. Responsibilities and Duties Translate business and systems requirements into technical test requirements Review and analyze client-specific system requirements and scope of services assigned by the QE Manager Collaborate with project team resources to understand and prioritize system testing efforts using Agile methodology Define system test scenarios, create system test plans, design and author test cases and participate in the definition and execution of manual and/or automated system test script Analyze and manipulate data to create system test data and system test cases for multiple or complex projects and to uncover issues within the application under Test Execute Systems Integration Test Plan including the comparison of actual results vs. expected results Document and report on identified system testing issues in VS-TFS and participate in or lead defect triage meetings Actively participate in multiple AGILE project teams and SCRUM status meetings as required.  Communicate project/work status and issues to QE lead/Manager. Evaluate, design, and develop test cases and automation scripts as appropriate using C#/Java/SQL. Participate in measuring and driving product quality from inception to release Monitor, measure, and improve software development and test processes Suggest and execute application design improvements and diagnose product problems and assist Development and Technical Support teams as needed Run manual and automated tests as part of a software release Lead User Acceptance Test efforts; coordinate with business users to secure resources, outline testing plan, and manage test effort thru deployment to production environment Develop and provide testing metrics and reports for the QE dashboard to effectively communicate test status to the test team and management. Troubleshoot and resolve or recommend solutions to a diverse range of complex software testing problems. Use judgment within defined policies and practices (includes software and technical documentation solutions). Assist with the Release Management process. Coordinate Sprint task updates and software releases from requirements stage to production release.   Requirements  Minimum Education and Experience:  Associate’s Degree with 5 years of progressively responsible work experience in Software Development and Quality Assurance Testing and Management. Military experience and education in the field of work related to the position’s role may be substituted on a year-for-year bases. Preferred Education:  Bachelor’s Degree in computer science, engineering or related field with at a minimum of 3years of progressively responsible work experience in Information Technology Development and Testing, preferably in a healthcare or managed care environment which provided the opportunity to gain the knowledge and skills required to perform the duties of the position. Knowledge and Skills Experience with Agile Methodology to ensure the stories contain specific acceptance criteria. Thorough knowledge and utilization of the Software Development Life Cycle (SDLC) process - including analysis, design, coding, system and user testing, problem resolution and planning Strong technical skills including a broad understanding of relational databases, file processing, application development, SQL and web-enabling technologies Must have experience with the following: Visio, SQL, and SharePoint Experience with test automation to include, Selenium, and/or a similar Test Automation Framework is a must. Experience providing quality control support to Health Care Organizations or Business Intelligence Customers Working knowledge of government quality control rules and regulations Ability to communicate effectively, both verbally and written, with subordinates, peers, and leaders at all levels of management Experience with Quality Engineering processes, procedures and releasing quality software into production. Ability to work independently and as a member of a diverse team, while building strong working relationships with customers and department leads Ability to execute project deliverables and tasks on time and on budget while supporting high quality software delivery  Preferred Skills and Certifications SCRUM/AGILE testing experience is preferred. Quality certification desired Mobile testing experience using emulators/devices and automation tools is a plus  Experience or familiarity with one or more of the following: software development processes, Software Engineering Institute (SEI) model, Capability Maturity Model (CMM), Capability Maturity Model Integrated (CMMI), software lifecycle.   Salary Range $68,359.62 - $117,679.31/Annually  

Submit Application and Resume to Alliance Health at  https://www.alliancehealthplan.org Reference Requisition SENIO001850 Alliance is currently seeking candidates for the role of Sr. Director, Care Management Operations. One Director will be based out of our Home Office in Morrisville NC and one in Charlotte NC. The Directors will oversee the smooth and efficient operation of Alliance’s Care Management department (CM) as directed by the SVP-Care Management and Population Health.  Core responsibilities shall include: oversight of all Care Management, Transition to Community Living (TCLI), Traumatic Brain Injury (TBI) and Medicaid C waiver programs. Receiving strategic direction from the SVP-Care Management and Population health, the incumbent will assist with the management of new and existing department initiatives across the Alliance catchment areas. The Senior Director of Care Management Operations is responsible for leading the development and overseeing the execution of policies and procedures and directing the standardization of policies, practices workflows and data reporting within the system.  The incumbent will manage key performance indicators and provide education/drive towards improvement to ensure quality patient care and adherence to all relevant compliance activities. This position will allow the successful candidate to work a flexible schedule with onsite being required 1-2 days a week a week as approved by their supervisor.  Responsibilities & Duties Oversee Department operations  Receiving strategic direction from the SVP-Care Management and Population Health, the Senior Director will assist with the management of new and existing department initiatives across all units in the Alliance catchment areas Collaborate and coordinate with the medical team to ensure the delivery of effective, efficient, integrated and evidenced based services and interventions.   With consultation from the SVP-Care Management and Population Health, ensure staff  in all of the Alliance catchment area are well trained in the use of Alliance clinical decision-making tools and practice guidelines Accountable for the training and development of the Care Management department in collaboration with the Organizational, Learning and Development team, overseeing all training activities of the Care Management Support team   Lead the department in the creation of training programs and materials. This role demands the ability to work collaboratively as well as independently, while handling multiple projects Oversee development of all training materials/workflows related to updated information or contractual requirements for all programmatic CM areas from the following: (NC State agencies, NC regulatory bodies, NC Contract, NCQA, HEDIS, & CM best practices), etc.  Review data for trends and analyze the impact on department operations.  Lead the implementation of improved clinical care management models to decrease readmissions, Emergency (ER) utilization, recidivism, and excessive length of stay;  Responds to  regulatory changes by education and leading the development of all policy/procedure changes relevant to the change Create and maintain spreadsheets and other relevant care management reports including, but not limited to, staffing, caseload, productivity, cm dashboards, Tailored plan, and auditing Train management, staff, and stakeholders on how to use and create reports for Care Management oversight and monitoring activities, programs, Tailored Plan initiatives, etc. Provide relevant, timely feedback to SVP-Care Management and Population Health regarding any adverse reporting results Manage and Develop Staff Work with Human Resources and SVP-Care Management and Population Health to maintain and retain a highly qualified and well-trained workforce  Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes Organize workflows and ensure staff understand their roles and responsibilities Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements Actively establish and promote a positive, diverse, and inclusive working environment that builds trust Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members Work to resolve conflicts and disputes, ensuring that all participants are given a voice Set goals for performance and deadlines in line with departmental and organization goals and vision Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development Cultivate and encourage efforts to expand cross-team collaboration and partnership Ensure Intradepartmental cooperation Collaborate and coordinate with the Chief Medical Officer, Executive Vice President/Chief Operating Officer, and Senior Vice President of Community Health to ensure effective operations of the division, support of organized care teams that deliver interventions and support under the care management model, and ensure intra-departmental cooperation on cross department initiatives Collaborate with Alliance IT teams to develop recurring or one-time departmental reports, as needed. Develop and implement department policies, procedures, process, and workflows Assist with writing and editing of new and existing policies, procedures, and workflows related to operation of the Care Management department and care management initiatives across the organization Communicate and report  Communicate and report effectively to Leadership at Alliance, to providers, to the community, to all staff and stakeholders as needed about service trends, identified gaps and needs, recommended implementation of new processes, practices and effectiveness of clinical model Foster and promote two-way communication and information sharing for successful program implementation and maintenance Lead the development of effective communication with internal and external customers to coordinate and adequately address patient care needs Provide accurate and pertinent information to appropriate departments, administration, medical staff, and others involved with CM activities Ensure Compliance Standards are met Work with Alliance’s Legal, Compliance, and Operations Division to ensure the department operates in compliance with NC State Agencies, CMS, EQR, and NCQA procedures, proactively identifies agency risk and implements corrective action when needed Assist with development and management of Department budget Remain cognizant of current Alliance and departmental spending trends and the effect on the availability of fiscal resources; discuss budget requirements and amendments with SVP-Care Management and Population Health ,as well as the Chief Medical Officer Review and respond to Member Care Issues/Incidents Recognize and respond to member care issues providing direction, feedback, and follow-up to staff or other healthcare team members. Escalate/Communicate any risk, high profile, member issues to CMO and SVP immediately-ensuring timely communication Minimum Education & Experience Bachelor’s degree in Nursing with RN license and seven (7) years of experience with the population served, including two (2) years of direct, progressive experience managing clinical and non-clinical resources/business areas. Health Plan Managed Care experience highly preferred.  Or Masters degree in Psychology, Social Work, Counseling, or related field and five (5) years of experience in mental health, substance abuse and/or developmental disabilities, including two (2) years of direct, progressive experience managing clinical and non-clinical resources/business areas. Requires experience leading and managing a broad and diverse business operation. Health Plan Managed Care experience highly preferred. Special Requirement Clinical License (RN, LCSW, LCMHC, LPA, or LMFT) and Drivers License  Knowledge, Skills, & Abilities Thorough knowledge of clinical management measures Thorough knowledge of systems management Thorough knowledge of strategic plan development Thorough knowledge of program evaluation Thorough knowledge of quality improvement processes Thorough knowledge of outreach strategies Knowledge of work culture enhancement Excellent customer service skills Excellent leadership skills Conflict resolution skills Ability to multi-task and work in a fast-paced environment with changing priorities Ability to communicate effectively Ability to build consensus Experience with and ability to manage key performance indicators Ability to develop trust, cooperation, and collaboration with administrative medical staff and departments across the system Ability to create consistent/standard work.  Salary Range  $83,249.92 to $143,312.59/Annually   

Submit Application and Resume to Alliance Health at  https://www.alliancehealthplan.org Reference Requisition DIREC001779  The Director of Quality Management develops strategies to drive continuous improvement through all levels of the organization. The Director works with other departments/divisions on the development of key metrics, data gathering, and compliance with quality system standards to align continuous improvement efforts with organization strategies and initiatives. This position will allow the successful candidate to work a primarily remote schedule. They must reside in North Carolina and will be required to come into the Alliance office in Morrisville or Charlotte, NC, for meetings with staff as needed. Responsibilities & Duties Develop and Implement Department goals and objectives Work with the SVP of Quality Management to establish and implement department goals and objectives. Work with the SVP of Quality Management to develop a quality management plan that defines and describes quality standards and assessments Research and incorporate best practices into quality management operations Analyze, updates, and modifies standard operating procedures and processes to continually improve department operations Oversee all regulatory body surveys; record concerns and develop procedures to handle concerns identified from survey data Staff Management and Development Work with Human Resources and the SVP of Quality Management to maintain and retain a highly qualified and well-trained workforce Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes Organize workflows and ensure staff understand their roles and responsibilities Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements Actively establish and promote a positive, diverse, and inclusive working environment that builds trust Ensure all staff are treated with respect and dignity Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members Work to resolve conflicts and disputes, ensuring that all participants are given a voice Set goals for performance and deadlines in line with organization goals and vision Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development Cultivate and encourage efforts to expand cross-team collaboration and partnership Collaborate with internal and external stakeholders on quality measurement/ performance initiatives Lead efforts on and collaborate with others on Healthcare Effectiveness Data and Information Set (HEDIS) performance Collaborate with state of North Carolina leaders on quality initiatives Review and implement new technological tools and processes and foster a team concept with internal and external stakeholders Support and collaborate with other leaders on Health Plan National Committee for Quality Assurance (NCQA) Accreditation and others Oversee quality improvement aspects of risk adjustment processes for all products Work collaboratively with other departments/divisions on the development of key metrics, continuous improvement, and compliance with quality system standards Oversee performance and outcome measurement activities including tracking key indicators throughout the year, aggregating data, analyzing quarterly and annual trends, and working collaboratively with program staff regarding follow-up activities and improvements, as required Work collaboratively with departments to identify opportunities to redesign processes that meet principles of enhanced effectiveness and efficiency within the organization Work with internal departments to support the Data Science team’s introduction of machine learning techniques, such as the automatic interpretation of multiple text fields in databases to reach decisions Collaborate with the provider network staff on gaps analyses and strategic planning Oversee development of quality improvement data gathering and reporting Present quality initiative findings and results of improvement efforts and ongoing performance measures to SVP of Quality Streamline the internal reporting process including the management of adhoc reporting request by creating an internal systematic process    Oversee appeals and grievance trending and reporting and collaborate with other leaders to mitigate risk Oversee analyses of data related to deviations of good clinical practice (GCP), including development of clear hypotheses and use of appropriate statistical analyses utilizing data from disparate sources (databases/tables) to develop actionable insights that support continuous process improvement Oversee efforts to automate the generation of Dashboards and Reports Develops, collects, prepares and analyzes quality of care data using computer designed data retrieval and storage; coordinates activities with the information technology department to collect information that can be used to examine patterns of outcomes of service delivery   Minimum Requirements Education & Experience Registered Nurse Required (Medicaid experience preferred)  Master’s degree in Nursing, Quality Management, Health Management or Healthcare related field required  Five (5) years’ demonstrated Statistics/analytics and/or quality management/quality improvement experience in a managed care environment preferred  Five (5) years of experience in a clinical healthcare setting   Three (3) years or more management experience. Training in data analysis, project planning or quality management is a plus.  Analysis tools such as SAS/SPSS/R, data storage principles and SQL is a plus Knowledge, Skills, & Abilities Thorough knowledge of public administration principles and methods, including goal setting, program development and administration, budgeting, and staff supervision Thorough knowledge of laws, rules and regulations governing LME/MCO activities and standards; Thorough knowledge of laws, rules and regulations governing LME/MCO activities and standards; Knowledge of the social, political and economic issues including available public and private community resources; Knowledge of principles of management and administration including planning, budgeting, human resource management, finance, and computer applications Experience with project management, lean, DMAIC, Six Sigma, Kaizen PDCA cycles, Pareto analysis, techniques for statistical analysis, survey design and methodologies, and training Extensive knowledge and understanding of business processes analysis and enhancing operations to accomplish business objectives Knowledge of the organization and functions of departments and agencies which comprise county government Strong analytical skills and ability to solve complex technical problems Familiarity with software programs (Word, Excel, Access, Visio, PowerPoint, and statistical software packages like SAS, SPSS, or R) as well as an understanding of data storage principles and SQL is necessary Ability to lead and motivate staff Ability to develop and implement goals, objectives, policies, procedures, work standards and internal controls Ability to analyze complex administrative and regulatory problems, evaluate alternatives and adopt effective courses of action Ability to prepare clear and concise reports, correspondence and make effective presentations Ability to exercise sound independent judgment within general policy guidelines Ability to develop proposals and programs which respond to long- and short-range problems detected during analysis Ability to develop proposals and programs which respond to long- and short-range problems detected during analysis Ability to comprehend and analyze complex organizational and procedural problems involving work production, work flow, forms, records, systems and staff utilization Ability to prepare and interpret a variety of reports, charts, layouts and other materials using computer and information services technology Ability to enlist the cooperation of officials of various agencies to implement policy and procedural changes Ability to present ideas effectively, both orally and in writing Salary Range $75,438.27 to $129,865.03/Annually 

Submit Application and Resume to Alliance Health at  https://www.alliancehealthplan.org Reference Requisition ODLSP001796  The Employee Experience Specialist develops and implements initiatives to build an outstanding employee work experience and a sustainable team-oriented, inclusive, and cooperative culture at Alliance Health. The incumbent assesses organizational culture and employee engagement and proposes activities to improve the workplace environment and strengthen employee and team engagement and performance. The role will partner with key members of the People Operations & Development (POD) division to enhance employee experience. This position will allow the successful candidate to work a primarily remote schedule which includes coming into the Alliance Home office (Morrisville, North Carolina) one to two days per week.  Responsibilities & Duties Employee Engagement Program Management Develop and implement engagement initiatives and programs that enable all employees to engage and align with the company mission, vision, and strategy  Advise leadership on engagement solutions that build on business and functional strategic drivers Design, communicate and implement short and long-term employee engagement strategies Support and develop initiatives to monitor and enhance employee engagement and experiences geared to attract and retain employees Nurture a healthy, positive company culture by serving as a co-leader of the Rewards & Engagement committee Lead preparation and execution of large-scale annual events  Design and facilitate team enrichment activities to support leaders by providing training on team cohesion, group dynamics, and immersive communication Create internal communications regarding learning programs to ensure employee are aware of development opportunities Develop and organize training manuals, multimedia visual aids, and other educational materials Program Evaluation and Improvement Interpret data and analytics to help provide strategic recommendations for team member engagement Analyze and quantify employee engagement results to create action item recommendations for management teams Collaboration Collaborate cross-functionally to integrate engagement strategies as part of the people life cycle at Alliance Health Partner with and support the HR Team to draw insights regarding themes and gaps and turn results into data-driven action plans  Partner with the Change Management Specialist to identify programs to drive overall company programs, events, and initiatives Partner with the Diversity, Equity & Inclusion Manager to recognize and reduce bias and increase fairness and transparency in our programs and initiatives  Assist the Onboarding Specialist with New Employee Orientation (NEO) and employee onboarding Partner with Engagement & Rewards Committee members to provide employee engagement coverage at all Alliance sites as needed Department Evaluation and Improvement Assist in ongoing and continuous needs assessments under guidance of the Director to help identify trends, changes, and opportunities ODL Administration Maintain training calendar and all documentation related to training classes and events Prepare reports on course evaluations and survey Manages live or remote classroom facilitation companywide  Manage the ODL inbox and classroom setup, as needed Minimum Requirements Education & Experience Bachelor’s degree from an accredited college or university in Sociology, Psychology, Education, Health Education, Human Resources, or a field providing background in organizational analysis and management development and seven (7) years of experience in a progressive training or teaching role; including experience in organizing training events, assessing needs, counseling, and evaluating sessions. Or Master’s degree from an accredited college or university in Sociology, Psychology, Education, Health Education, Human Resources, or a field providing background in organizational analysis and management development and five (5) years of experience in a progressive training or teaching role; including experience in organizing training events, assessing needs, counseling, and evaluating sessions. Preferred: PHR, SPHR, SHRM-CP or SHRM-SCP certification Knowledge, Skills, & Abilities Knowledge of organizational development systems, theories, and practices, including accepted methods of measurement and assessment, and practices of leadership and organizational development. Advanced knowledge of cultural diversity issues  Excellent communication skills  Exceptional collaboration skills Ability to display sensitivity in interactions with various and diverse members of the staff and community Skills in problem-solving, mediation, conflict resolution and team building are essential. Demonstrated ability to formulate and present ideas effectively, either verbally or in written form Ability to establish and maintain effective working relationships with supervisors and staff  Ability to adapt and communicate information to a wide range of audiences and situations Ability to work with little supervision Salary Range: $58,967.33 to $101,510.73/Annually

Submit Application and Resume to Alliance Health at https://www.alliancehealthplan.org Reference Requisition DATAE001857 The Data Engineer is responsible for working collaboratively with different IT roles to design and develop advanced healthcare data interoperability solutions using multiple tools and programming languages. The Data Engineer uses industry standards and best practices to develop data integration solutions that support key strategic organizational priorities. This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office at Morrisville may be required.  Responsibilities & Duties Analyze business and technical requirements for the design of data integration solutions Define the overall data integration and dataflow architectures to support data integration projects Design and develop SQL and SSIS processes to support data integration projects Design and develop APIs to consume and distribute healthcare data Design, develop and execute unit testing plans Ensure data quality and integrity in all data integration projects Develop technical and business process documentation for data integration projects Maintain and continually improve data integration projects Assist in establishing standards for the design, development, implementation and support of data integration projects Provide data integration support and collaborate on data requirements and needs with internal and external stakeholders Any other tasks as reasonably required Knowledge, Skills, & Abilities Expert programming in SQL Proficient designing and developing ETL processes, preferably using SSIS Proficient designing and developing APIs, preferably using .NET Framework Experience with healthcare interoperability tools and protocols, including FHIR, HL7, CDA and EDI Experience working with API management and data integration platforms such as Apigee or MuleSoft Experience with healthcare data, including CMS-1500, UB-04, EDI 837 and NCPDP Experience working with HIEs and/or HISPs Strong communication and organizational skills Ability to access and analyze large data sets for completeness and quality Ability to work independently and in a team setting Education & Experience Required: Graduation from a Community College or Technical School with a major in computer science or related field and six (6) years of experience in a computer science related field including experience in a data integration or ETL development position or an equivalent combination of education and experience that includes developing complex data integration software applications. Military experience and education in the field of work related to the position's role may be substituted on a year-for-year basis. Preferred: Bachelor’s degree plus 5 years of experience in a computer science related field including experience in a data integration or ETL development position or an equivalent combination of education and experience that includes developing complex data integration software applications. Microsoft Certified Solutions Expert, MuleSoft Certified Developer and/or HL7 Certifications are a plus. Salary Range $83,249.92 - $143,312.59/Annually 

Description The Internal Auditor II provides senior level staff advisory, consultative, and audit work to include the preparation of audit programs and independent review of various functions, policies, and programs for soundness, adequacy, and application. The position ensures resources are efficiently and effectively employed, operating in compliance with the Institute of Internal Auditors International Standards and brings a systematic and disciplined approach to evaluating and improving governance, risk management and internal control in the achievement of business objectives. This position will allow the successful candidate to work a flexible and primarily remote schedule. A minimum of one day a week working in-office will be required. Responsibilities & Duties Auditing Drive internal audit initiatives, special projects, and improvement initiatives. Design and implement key metrics. Evaluate the adequacy, effectiveness and efficiency of the systems of internal control of ongoing operations Perform detailed review of work files. Review audit responses and action plans developed by the auditee/management. Conduct periodic audit follow-up reviews to assess and report on progress or completion of management’s corrective actions. Conduct other audit and compliance activity, such as internal investigations, as assigned. Prepare internal audit and consulting reports for completed engagements for Director of Internal Audit review. Design and Implement Internal Controls, Strategy, Policies, and Procedures  Implement and promote internal audit policies and standards. Define and implement audit methodology procedures, tools, etc. Align audit activities with internal audit strategy, goals, and objectives. Design and review audit work programs, testing strategies, and detailed testing procedures. Assist in defining and managing content for the internal audit manual. Develop and review engagement scope and objectives. Contribute to the development of the internal audit training program; work with supervisor to establish training goals. Risk Management Actively participate in all phases of risk assessment and annual audit planning and execution. Assist in the annual system-wide Enterprise Risk Management risk assessment cycle Staff Advisor Provide first level of review on audit issue and report write-ups completed by internal audit staff. Provide mentoring and coaching to internal auditor staff and compliance auditors (analysts). Communication & Relationship Management Effectively communicate with internal audit staff, Director of Internal audit, and Alliance management. Build relationships with key constituents and serve as a resource of professional advice, as appropriate. Build and nurture key management and business relationships Manage external relationships – external auditors, regulators and consultants.  Communicate the results of audit activities via written reports and oral presentations to auditee management when needed, to other specified stakeholders.  Minimum Requirements Education & Experience Bachelor’s degree in accounting, business administration or other appropriate area from an accredited college or university plus a minimum of seven (7) years’ auditing experience, or experience related to the field, including three (3) years in managed care or government in a compliance or audit capacity;  or  Master’s degree in accounting, business administration or other appropriate area from an accredited college or university plus a minimum of five (5) years’ auditing experience, or experience related to the field, including three (3) years in managed care or government in a compliance or audit capacity.  Contract review and/or delegation experience is strongly preferred One of the following professional certifications is required Certified Internal Auditor (CIA) Certified Public Accountant (CPA) Certified Fraud Examiner (CFE) Certified in Healthcare Compliance (CHC) Accredited Healthcare Fraud Investigator (AHFI) Certification in Risk Management Assurance (CRMA) Certified Information Systems Auditor (CISA) Certified Financial Analyst (CFA) Certified Management Accountant (CMA) Certified Financial Services Auditor (CFSA)   Knowledge, Skills, & Abilities- Knowledge in auditing standards, compliance standards, enterprise risk management, and audit best practices. Knowledge of state and federal Medicaid laws, administrative rules, state policies, and other guidelines. General understanding of all major MCO functions. Particularly as they relate to claims processing, utilization reviews, grievance management, provider credentialing, and contracting. Ability to interpret contractual agreements and other business documents. Ability to maintain confidentiality and handle highly sensitive information with discretion. Ability to evaluate financial documents for accuracy, completeness, and compliance. Ability to communicate professionally and succinctly with various stakeholders. Excellent analytical, decision-making, and time management skills. Ability to analyze financial data and identify concerning trends, patterns, and other risks. Knowledge of investigative techniques and methods, such as interviewing, gathering evidence, etc. Advanced computer skills in Microsoft Office (e.g., Word, Excel) Ability to maintain professional competencies related to the internal audit profession, internal control issues, and other relevant topics. Salary Range $68,360-$117,679/Annually

Description The Quality Improvement Specialist II plans and executes organization-wide improvement projects in order to improve organizational performance and promote efficient use of resources through effective design, measurement and analysis of key clinical and operational processes.  Applies statistical techniques, root cause analysis, Lean, Six Sigma, and other process improvement tools and techniques with subject matter experts to drive effective interventions and track the implementation of those interventions. The Quality Improvement Coordinator will manage several projects simultaneously. This position is fulltime remote. Some travel to onsite meetings may be required.  Functions & Duties Manage interdepartmental projects to achieve quality targets Form a team of experts required for effective completion of the project, documenting the projected resources, dates, and goals Develop and adhere to a timeline and list of tasks and resources should be generated that will describe the project in detail and plot important dates, meetings, and prospective finish Prepare and present project reports on a regular basis to the Project Team, Executives, and the Board of Directors Conduct regular meetings with team members to discuss the status of the project and also to make necessary changes and improvements to achieve the desired results Motivate and influence staff assigned to the project in order to accomplish task(s) successfully Statistics, Sociology, Economics, Public Health, Business Administration, Organizational Development, Psychology or related social science Identify and promptly address any problems that may pose a risk to achieving the desired outcome of the project within the time and budget constraints Create and deliver presentations and trainings to variety of internal and external stakeholders as needed Identify the root causes of quality issues to ensure the problem is well defined and can be addressed Leverage lean concepts to identify nonvalue-added elements and activities, and are able to use quality tools to identify failure points in processes Conduct process mapping exercises, design effective data collection plans, understand sources of performance variation, and communicate these principles effectively to a broad audience Define success targets based on internal and external requirements as well a well thought out business case Effectively measure the key output variables to ensure all performance changes are accurately assessed Conduct statistical analysis of initial and repeat measures to evaluate efficacy of interventions and to improve approach to successfully resolving root cause as needed Design appropriate sampling plans and measurement systems to assess process capability and overall system performance Evaluate validity and accuracy of data sources to draw appropriate conclusions Analyze changes in performance to determine the impacts of interventions Perform any required data analysis to evaluate performance gaps  Prepare comprehensive reports to ensuring adequate documentation and methodology to support findings and recommendations Design and lead the implementation of effective interventions to drive improvement Generate and evaluate solution ideas using Lean methodologies to reduce and prevent waste Develop plans for implementing proposed improvements, including conducting pilot tests or simulations, and evaluate results to select the optimum solution. Develop a sustainable monitoring process and procedure that will ensure long-term success Verify reduction in failures due to the targeted root cause Ensure that all staff involved in the improvement efforts are trained to sustain the improvements and have a robust monitoring plan to detect future performance issues Knowledge, Skills, & Abilities required Advanced Project Management skills Advanced Quality Improvement Methodologies (Lean, Six Sigma, Kaizen, etc.) Advanced Data Collection & Analysis skills Advanced Microsoft Applications (Excel, Word, PowerPoint etc.) skills Advanced Communication Skills Advanced Collaboration Skills (problem-solving, mediation, conflict resolution and team work) Knowledge and experience with NCQA and HEDIS measurements Medicaid Experience  Financial management skills Minimum Education & Experience Bachelor’s degree and five (5) years of experience leading project teams focused on large-scale quality improvement efforts and/or experience gathering, editing, and analyzing data for social and economic research;  or   Master’s degree and three (3) years of experience leading project teams focused on large-scale quality improvement efforts and/or experience gathering, editing, and analyzing data for social and economic research.  Special Requirement Certification as a Lean practitioner and/or Six Sigma Black Belt is required within eighteen (18) months of employment   Salary Range $61,945.18  to $ 106,637.02/Annual