Care Manager I-DSS (Full-Time Hybrid, North Carolina Based) (Personal Services)

The Care Manager I-DSS is the primary point of contact for members connected to Department of Social Services, Department of Juvenile Justice, and other multi-system involvement. This includes supporting the foster care population that is receiving adoption assistance and former foster youth. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Medicaid Direct and Tailored Plan recipients and relays communication among providers of health services.

The Care Manager l - DSS assures that individuals and families with special health care needs receive integrated whole-person care management, including coordinating across physical health, behavioral health, pharmacy and unmet health-related resource needs to ensure they are linked to services and supports in an effort to maximize potential outcomes and decrease the unnecessary use of hospitals and emergency services by assuring that appropriate quality care is in place.

This position is a provisional appointment and is expected to end in December 2025

This is a Hybrid position. The candidate is not required to come into the home office weekly, however the candidate must be willing to come into the home office if needed for a weekly meeting.

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 as appropriate for monitoring and service engagement activities 
• Submit referral to the Care Management Consultant team 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 evaluate 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
• Participate in child and family team meetings, and/or other DSS defined meetings to support plans of care and cross-system communication and collaboration

Provide Support and Monitoring

• Schedule initial contact with member/LRP to verify accuracy of demographic information and obtain necessary information/documents
• Update inaccurate information from the Global Eligibility File
• 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
• Assist members who are in crisis/institutional care settings and require assistance with returning to community-based services
• 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 when applicable
• 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 
• Provide clinical and administrative consultation for DSS and other stakeholders
• Provide system navigation for DSS, the adoption assistance/former foster youth population, and other stakeholders to understand and work within the behavioral health system 

Complete Documentation

• Document all applicable member updates and activities per organizational procedure
• Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements
• Escalate complex cases and cases of concern to Supervisor
• Ensure that service orders/doctor's orders are obtained, as applicable  
• 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
• Obtain releases/documentation and provide applicable information to all stakeholders involved. 
• Proactively respond to an individual's planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care

Minimum Requirements

Bachelor's degree from an accredited college or university in Human Services field and two (2) years of post-bachelor's degree MH/DD/SA experience with the population served

Or

Bachelor's degree from an accredited college or university in Non-Human Services field and four (4) years of post-bachelor's degree MH/DD/SA experience with the population served

Or

Master's Degree from an accredited college or university in Human Services field and one (1) year of post graduate degree MH/DD/SA experience with the population served

Or 

Fully or Provisionally Licensed in the State of North Carolina as a LCSW, LCMHC, LPA, or LMFT 

Or

Licensed Registered Nurse (RN) in the State of North Carolina with four (4) years of MH/DD/SA experience with the population served

Preferred: Knowledge and experience collaborating with county departments of social services, department of juvenile justice, crisis response, and community-based treatment providers including training highly preferred. NACCM, NADD-Specialist and/or CBIS Certification

Knowledge, Skills, & Abilities

• Person Centered Thinking/planning
• Knowledge of using assessments to develop plans of care
• Knowledge of Diagnostic and Statistical Manual of Mental Disorders
• Knowledge of LOC process, SIS for IDD and FASN assessment for TBI
• Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans
• Knowledge of and skilled in the use of Motivational Interviewing
• Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.)
• Strong interpersonal and written/verbal communication skills essential, including 
• Conflict management and resolution skills
• High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
• Ability to make prompt, independent decisions based upon relevant facts

 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:

$58,480 - $76,024/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

Education

Preferred

• Bachelors or better in Human Services

Licenses & Certifications

Required

• Driver License

See job description