Role Description
The Complex Case Manager will engage and support members with the highest complexity, including:
• Multiple chronic conditions
• Severe mental illness (SMI)
• Substance use disorder (SUD)
• Intellectual/developmental disability (I/DD)
• Mobility impairments
• Frequent emergency department (ED) and inpatient utilization
• Social complexity
The role also requires periodic onsite visits with members in hospital and/or residential settings. There is no expectation of coming into the office routinely; however, the selected candidate must be available to report onsite to the Alliance Office for business meetings as needed. Additionally, you will travel weekly to meet stakeholders within either Harnett/Johnston or Wake/Durham counties, depending on your home location. Therefore, you must reside within a 40-mile radius of these served catchment areas.
Responsibilities & Duties
• Initial Member Engagement
• Contact the member, the member’s authorized representative, treating physician, and other providers as needed to collaboratively address identified health and care coordination needs.
• Inform members about how they became eligible for case management, how to utilize program services, and their option to decline the program via phone or in person.
• Schedule assessment with member and/or authorized representative within appropriate timeframes.
• Develop individualized, goal-oriented care plans in a standardized format; providing continuous coordination, including timely post-acute follow-up and linkage to community resources.
• Document engagements with members in Alliance’s electronic care-management system.
• Ongoing Engagement, Assessments, and Care Plan Development
• Perform assessment, planning, implementation, coordination, monitoring, and evaluation throughout the continuum of care, providing evidence-based, person-centered care planning consistent with recognized standards of case management practice and accreditation requirements.
• Empower members and their families by providing information and education that promote self-maintenance, monitoring, and management to facilitate positive behavior change.
• Deliver timely, targeted evidence-based interventions that drive measurable progress toward person-centered goals.
• Promote medication safety through reconciliation and ongoing adherence monitoring.
• Educate and engage members and families in coordinating appropriate services to maximize health plan benefits and available resources.
• Provide members with ongoing care coordination within community resources to address members' social determinants of health (SDOH) needs.
• Provide transitions of care supports to identify and address members’ needs and gaps in care to mitigate the risk of an avoidable ED visit or prevent potential inpatient readmissions.
• Collaborate with member’s care team to help promote improved member and provider satisfaction.
• Knowledgeable of HEDIS measurements and population health within a complete care model.
• Monitoring/Coordination
• Conduct regular follow-up meetings with members and/or caregivers over the phone, virtually, or in person.
• Participate in weekly Multidisciplinary Team meetings to include a Medical Director, CM consultants, Pharmacy, and Community Health Workers for collaborative solutioning of complex cases.
• Assess members every 90 days to determine if CCM criteria are still met.
• Warm handoff to Community Care Management to ensure continuity of care and ongoing care coordination of services.
• Documentation
• Ensure all clinical documentation (e.g., goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements.
• Follow administrative procedures and effectively manage caseload.
• Travel
• Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance-sponsored events, etc. may be required.
• Travel to meet with members, providers, stakeholders, attend court hearings, etc. is required.
Qualifications
• Registered Nurse with valid RN licensure and two (2) years of full-time, post-degree experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions.
• Or Master’s degree in Human Services or related field and two (2) years of experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions. Full licensure LCSW, LMFT, LCAS, LCMHC, LPA required.
• Bachelor’s Degree from an accredited Program in Nursing and two (2) years of full-time, post-bachelor’s degree experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions and/or Complex Care Case Management.
• Care Management Certification preferred.
Knowledge, Skills, & Abilities
• Demonstrated knowledge of the assessment and treatment of mental health, substance abuse, intellectual and developmental disabilities.
• Knowledge of legal, waiver, accreditation standards, and program practices/requirements.
• Knowledge of the Alliance Health service benefit plans and network providers.
• Person Centered Thinking/planning.
• Detail-oriented.
• Ability to independently organize multiple tasks, priorities, and effectively manage an assigned caseload under pressure of deadlines.
• Exceptional interpersonal skills, highly effective communication ability.
• Ability to make prompt independent decisions based upon relevant facts and established processes.
• Problem solving, negotiation, and conflict resolution skills.
• Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required.
Salary Range
$69,592-$90,469 /Annually. Exact compensation will be determined based on the candidate's education, experience, external market data, and consideration of internal equity.
Benefits
• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility