Manager-Tailored Care Management-I/DD (Hybrid, North Carolina Base)

The Manager- Tailored Care Management- I/DD position oversees the supervision of care management efforts to support clinically complex members with intellectual and/or developmental disabilities and co-occurring acute and chronic conditions, across the age spectrum.  

In addition, the manager is responsible for overseeing all day-to-day activities including regular monitoring of JIVA activity compliance, documentation, audit compliance, corrective actions, management of staffing ratios, risk stratification, caseload distribution, referral distribution, and appropriateness of case escalation.

The selected candidate is required to reside in North Carolina within 40 miles of one of the counties within the Alliance catchment areas (Mecklenburg, Wake, Durham, Orange, Johnston, Harnett, or Cumberland). Travel will be required as needed for business operations to areas throughout the catchment area, including the Morrisville office and the Mecklenburg County office.

Responsibilities & Duties

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
• Ensure a whole person model of care by fostering integration of integrated care roles (i.e. RN, OT, CHW, etc.) as a part of the care management team

Collaborate with External, and Internal Stakeholders

• Collaborate with leadership within the Population Health - Care Management and Practice Transformation department to ensure a cohesive and well coordinate approach by staff to achieve a whole person care approach driving positive member outcomes
• 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 Provider Networks, Provider Network Evaluation, Practice Transformation, Member and Recipient Services, and other internal departments 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 standards
• Ensure regular oversight of Supervisors’ monthly tasks and responsibilities 
• Ensure I/DD services are allocated and opened timely and in compliance with policy and procedure 
• Develop workflows and desk procedures specific to the scope of work pertinent to the I/DD population
• 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 and case management for the I/DD population
• Ensure a whole person model of care by fostering integration of integrated care roles (i.e. RN, OT, CHW, etc.) as a part of the care management team

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

• Accountable to ensure desk references, workflows, and operational procedures are implemented, reviewed, and revised to support care management excellence in line with state, federal, and health plan requirements through an evidence-based best practice lens.
• Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

Minimum Requirements

Education & Experience

Graduation from an accredited school of nursing with Licensure as a registered nurse and five (5) years of experience with at least three (3) years of applicable experience with the population served, including experience with care management, case management, or care coordination in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care to complex individuals with an I/DD or TBI.

Or

Master’s degree from an accredited college or university in Human Services and five (5) years post graduate degree experience with at least three (3) years of applicable experience with the population served, including experience with care management, case management, or care coordination in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care to complex individuals with an I/DD or TBI.  

Must be licensed in North Carolina as a LCSW, LCMHC, LPA, LMFT or RN

Preferred: 

• Experience with managed care and population health management
• At least one (1) year of work experience, working for a provider serving persons with LTS support needs
• Experience providing care management, case management, or care coordination to complex individuals with IDD or TBI
• Two (2) years of supervisor experience overseeing programs related to the I/DD population
• NACCM, NADD-Specialist, CCM or CBIS certification

Knowledge, Skills, & Abilities

• Knowledge of Medicaid program policies and procedures and   understanding of long term care programs and terms of coverage
• Considerable knowledge of populations being served and available resources in the community
• Knowledge of Medicaid basic, enhanced MHSUD, and Medicaid C waiver benefits plans
• Knowledge of and skilled in the use of MS Office Products including Outlook, Excel and Word
• Detail-oriented and able to organize extensive amounts of clinical data, multiple tasks and priorities
• Knowledge of research and best practice development in clinical practice
• Knowledge of Medicaid basic, enhanced MHSUD, and Medicaid C waiver benefits plans
• Knowledge of Tailored Plan standards or procedures
• Knowledge of the NC Division of Mental Health, Developmental Disabilities and Substance Abuse IPRS Target Populations and Service Array
• Knowledge of LOC process, SIS for IDD and FASN for TBI
• Knowledge of applicable Federal laws, including Substance Abuse and HIPAA Privacy Laws.
• Ability to effectively manage projects from start to finish
• Ability to adapt and shift focus according to mandated changes and changing priorities within the department
• Ability to access and interpret information and propose solutions to address issues and specific consumer needs and situations.  
• High level of diplomacy and discretion
• Ability to effectively negotiate and resolve issues with minimal assistance.
• Exceptional interpersonal skills
• Ability to communicate effective orally and written
• Ability to make prompt, independent decision based on relevant facts
• Problem solving, negotiation, and conflict resolutions skills
• Highly skilled at assuring that both long- and short-range goals and needs of the individual are addressed and updated, while also assuring through monitoring activities that service implementation is occurring appropriately

Want to learn more about what it's like work as part of the Care Management Team? Click on our video to learn more: https://youtu.be/1GZOBFx61QU 

Salary Range 

$86,800-112,840/Annually 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

 An excellent fringe benefit package accompanies the salary, which includes:   

• 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 

Salary : $86,800 - $112,840