Job Description Bilingual Spanish/English Required This is a telework role, but candidates must be licensed in the state of CA. Working schedule: Monday-Friday, 8am-5pm. Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary/Mission Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Fundamental Components • Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. • Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits. • Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. • Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. • Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. • Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences • Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Pay Range The typical pay range for this role is: Minimum: 26.59 Maximum: 57.21
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications – Bilingual Spanish/English Required – 3+ years of clinical practical experience as an RN – Registered Nurse with active CA state license in good standing
Preferred Qualifications – 2+ years of case management, discharge planning and/or home health care coordination experience – Experience working with adult and senior populations – CCM preferred – Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually – Excellent analytical and problem-solving skills – Effective communications, organizational, and interpersonal skills. – Ability to work independently – Effective computer skills including navigating multiple systems and keyboarding – Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, and Outlook
Education – Associates degree required – Bachelor’s degree preferred
Business Overview Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Oct 27, 2022
Full time
Job Description Bilingual Spanish/English Required This is a telework role, but candidates must be licensed in the state of CA. Working schedule: Monday-Friday, 8am-5pm. Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary/Mission Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Fundamental Components • Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. • Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits. • Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. • Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. • Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. • Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences • Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Pay Range The typical pay range for this role is: Minimum: 26.59 Maximum: 57.21
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications – Bilingual Spanish/English Required – 3+ years of clinical practical experience as an RN – Registered Nurse with active CA state license in good standing
Preferred Qualifications – 2+ years of case management, discharge planning and/or home health care coordination experience – Experience working with adult and senior populations – CCM preferred – Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually – Excellent analytical and problem-solving skills – Effective communications, organizational, and interpersonal skills. – Ability to work independently – Effective computer skills including navigating multiple systems and keyboarding – Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, and Outlook
Education – Associates degree required – Bachelor’s degree preferred
Business Overview Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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
Sep 23, 2022
Full time
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
Alliance Health
Morrisville and Charlotte North Carolina
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
Sep 23, 2022
Full time
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 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
Sep 23, 2022
Full time
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
Sep 23, 2022
Full time
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
Alliance Health
Morrisville, Durham, Cumberland and Smithfield North Carolina
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
Sep 23, 2022
Full time
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