Care Management Consultant

Jobtailor

Morrisville (NC)

On-site

USD 70,000 - 110,000

Full time

14 days+

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Job summary

Jobtailor in Morrisville, NC is seeking a licensed RN or OT/PT professional to lead care coordination and management for members with Behavioral and Physical Health needs. You will perform assessments, care planning, medication reconciliation, and data-driven care enhancements while collaborating with care teams and community partners.

The role emphasizes person-centered planning, strong documentation, and adherence to Medicaid requirements, ensuring timely reviews and quality outcomes for

Qualifications

Graduation from an accredited nursing school with three (3) years of full-time, post-degree experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions.
Must have an active, valid RN license in North Carolina.
Or Master’s degree from an accredited college or university in Occupational Therapy or Physical Therapy and two (2) years of full-time, post-master experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions.
Must have an active, valid OT or PT license in North Carolina.
Knowledge of the assessment and treatment of mental health, substance abuse, intellectual and developmental disabilities.
Knowledge of legal, waiver, accreditation standards and program practices/requirements.
Knowledge of the Alliance Health service benefit plans and network providers.
Person Centered Thinking/planning.
The employee must be detail oriented.
Ability to independently organize multiple tasks, priorities, and to effectively manage an assigned caseload under pressure of deadlines.
Exceptional interpersonal skills, highly effective communication ability.
Ability to make prompt independent decisions based upon relevant facts and established processes.
Problem solving, negotiation and conflict resolution skills.
Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required.

Responsibilities

Provide Care Team Support.
Support members transitioning from institutional care settings to community-based care
Provide subject matter expertise, within scope, regarding member’s physical and/or behavioral health to support the development and delivery of a whole person approach to Care Management
Work collaboratively with other Alliance staff, behavioral health providers, primary care physicians, specialty care providers and other community partners and stakeholders to support members in their home communities
Complete Assessments and Planning
Utilize person-centered planning, motivational interviewing, and assessments to gather information and care planning
Address concern(s) and/or questions from internal CM staff about the physical health/treatment/medications for our members
Educate team members about impact of member’s health conditions on service engagement, clinical outcomes, and prognosis
Actively collaborate with member and care team members to ensure care plan accurately reflects the individual’s clinical needs and desired life goals
Collaborate with our internal Care Management staff and provide consultation regarding members with specialized physical health needs, transitions between care settings, and physical health needs identified via the assessments and care plan generation
Provide medication reconciliation and education
Consult with Pharmacy Team for Polypharmacy concerns as appropriate
Provide Physical Health Consultation to Internal Care Management team members for questions related to member’s Physical Health (i.e., CHF, Diabetes)
Medication Management
The Physical Health Consultant will process and prioritize referrals from Care Management staff to ensure a medication reconciliation is completed
Contact via phone or email the member and/or guardian to schedule an appointment to review member’s medications
Review of members medical history to identify risk factors including recent hospitalizations, emergency room visits, seeing more than one physician, polypharmacy, or any new diagnoses
Connect with members at scheduled appointment times via telephone or virtually
Review and address Medication Adherence barriers
Consult and elevate cases to Alliance’s Pharmacy team according to process and standard procedure
Documentation
Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements
Follow administrative procedures and effectively manages caseload
Data
Review, validate and interpret risk stratification data and population health groups and recommend changes or adjustments to care management approach as needed
Utilize data to analyze needs of the members we serve, guide staff training development, identify resource needs and consistency of workflow implementation across disciplines

Skills

Care Coordination

Assessment and Planning

Medication Reconciliation

Data Analysis

Risk Stratification

Person Centered Thinking

Education

RN license in North Carolina

OT/PT license in North Carolina

Tools

Microsoft Office Suite

Job description

Provide Care Team Support
Support members transitioning from institutional care settings to community-based care
Provide subject matter expertise, within scope, regarding member’s physical and/or behavioral health to support the development and delivery of a whole person approach to Care Management
Work collaboratively with other Alliance staff, behavioral health providers, primary care physicians, specialty care providers and other community partners and stakeholders to support members in their home communities
Complete Assessments and Planning
Utilize person-centered planning, motivational interviewing, and assessments to gather information and care planning
Address concern(s) and/or questions from internal CM staff about the physical health/treatment/medications for our members
Educate team members about impact of member’s health conditions on service engagement, clinical outcomes, and prognosis
Actively collaborate with member and care team members to ensure care plan accurately reflects the individual’s clinical needs and desired life goals
Collaborate with our internal Care Management staff and provide consultation regarding members with specialized physical health needs, transitions between care settings, and physical health needs identified via the assessments and care plan generation
Provide medication reconciliation and education
Consult with Pharmacy Team for Polypharmacy concerns as appropriate
Provide Physical Health Consultation to Internal Care Management team members for questions related to member’s Physical Health (i.e., CHF, Diabetes)
Medication Management
The Physical Health Consultant will process and prioritize referrals from Care Management staff to ensure a medication reconciliation is completed
Contact via phone or email the member and/or guardian to schedule an appointment to review member’s medications
Review of members medical history to identify risk factors including recent hospitalizations, emergency room visits, seeing more than one physician, polypharmacy, or any new diagnoses
Connect with members at scheduled appointment times via telephone or virtually
Review and address Medication Adherence barriers
Consult and elevate cases to Alliance’s Pharmacy team according to process and standard procedure
Documentation
Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency, and Medicaid requirements
Follow administrative procedures and effectively manages caseload
Data
Review, validate and interpret risk stratification data and population health groups and recommend changes or adjustments to care management approach as needed
Utilize data to analyze needs of the members we serve, guide staff training development, identify resource needs and consistency of workflow implementation across disciplines

Requirements

Graduation from an accredited school of nursing school and three (3) years of full-time, post degree experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions.
Must have an active, valid RN license in North Carolina.
Or Master’s degree from an accredited college or university in Occupational Therapy or Physical Therapy and two (2) years of full-time, post master’s degree experience providing care management, case management, or care coordination to members with Behavioral Health and Physical Health conditions.
Must have an active, valid OT or PT license in North Carolina.
A demonstrated Knowledge of the assessment and treatment of mental health, substance abuse, intellectual and developmental disabilities.
Knowledge of legal, waiver, accreditation standards and program practices/requirements.
Knowledge of the Alliance Health service benefit plans and network providers.
Person Centered Thinking/planning.
The employee must be detail oriented.
Ability to independently organize multiple tasks, priorities, and to effectively manage an assigned caseload under pressure of deadlines.
Exceptional interpersonal skills, highly effective communication ability.
Ability to make prompt independent decisions based upon relevant facts and established processes.
Problem solving, negotiation and conflict resolution skills.
Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required.

Core Competencies

Demonstrates expertise in Care Management and Case Coordination, with a focus on Behavioral and Physical Health conditions. Proficient in Person-Centered Planning, Medication Management, and effective communication with multidisciplinary teams.

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