Job Description
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. 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 Office (Charlotte, North Carolina) for business meetings as needed. The successful candidate will also be required to travel weekly throughout Mecklenburg and surrounding counties (including ones outside of Alliance’s catchment area) to meet with members, providers and/or other community stakeholders. 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, an