Complex Case Manager (Full Time, Remote, North Carolina Based

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, and 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.
In addition, 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.

• 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 time frames
• Develop individualized, goal-oriented care plans in a standardized format; and 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

• Perform assessment, planning, implementation, coordination, monitoring and evaluation throughout the continuum of care, and provide evidence-based, person-centered care planning which is 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 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

• Conduct regular follow-up meetings with members and/or caregiver 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 still met
• Warm handoff to Community Care Management to ensure continuity of care and ongoing care coordination of services

• Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements
• Follow administrative procedures and effectively manages caseload

• 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

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…