Mgr-Care Management Support; Hybrid, North Carolina

Position: Mgr-Care Management Support (Full-time Hybrid, North Carolina Based)
The Manager-Care Management Support provides oversight and direction to the teams providing care coordination and other support in Care Management. As the leader of the supervisory team, the Manager of Care Management Support is responsible for ensuring that the teams are performing efficiently and effectively and are in compliance with all applicable policies and contractual requirements, which include, but are not limited to, auditing of work tasks, resolving member issues, reviewing reports, and developing work processes.

This is a full-time hybrid opportunity. There is no expectation of coming into the office routinely, however, the selected candidate must be available to report onsite to the Alliance Offices if needed to attend business meetings. They will also be expected to travel throughout the Alliance catchment area for business needs. Selected candidate must reside in North Carolina

Staff Management and Development

• Work with Human Resources and Director of Care 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 External and Internal Stakeholders

• Develop strong working relationships with providers and external stakeholders by scheduling ongoing opportunities to share feedback and collaborate
• Participate in local, regional, and state meetings as required
• Exercise conflict resolution skills to appropriately resolve issues with providers and external stakeholders
• Develop strong working relationships within other departments such as Provider Networks, Provider Network Evaluation, I.T. and Practice Transformation by scheduling ongoing opportunities to share feedback, collaborate, and identify shared responsibilities for achieving program and organizational deliverables

Implement Recommendations for Continuous Quality Improvement

• Review, validate and interpret risk stratification data and population health groups and recommend 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
• Implement recommendations to improve department procedures and increase operational efficiency
• Monitor trends and identify opportunities for enhancements in service utilization and implementation throughout Alliance

Oversee Program Operations and Development

• Develop and support program operations in new Alliance regions, while adhering to Tailored Plan, Medicaid Direct and State-Funded standards
• These programs cover areas included but not limited to Transitions of Care, support to DSS and Provider Led Entities, members who have justice involvement, and residential placements
• 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

Oversee Documentation Maintenance and Reporting

• Maintain medical record compliance/quality
• Ensure timely documentation of Care Coordination activities as required by department policy and procedures
• Monitor completion of documentation in all systems to ensure data is entered timely and accurately
• Oversee the collection and delivery of data requests impacting program operations

Comply with Policies, Procedure, Processes, and Workflows

• Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

Minimum Requirements

Education & Experience

Master's degree from an accredited college or university in…