Dir-Waiver Care Management (Remote, North Carolina Based)

The Director of Waiver Care Management oversees a team of supervisors, managers, and Care Managers and/or other care management staff that perform care management activities.

The Director monitors behavioral health and physical health outcomes for those served by Alliance Care Teams and collaborates with Utilization Management, Medical Management, Community Health and Well Being, Finance/Eligibility and Provider Network leaders within Alliance Health to ensure that the desired care management outcomes are consistent with Care Management requirements, policies, and procedures.

The Director will also ensure development and implementation of contractual requirements specific to care management and waiver programs. The Director develops methods of collecting, analyzing, interpreting, and sharing of data specific to the member experience and care management outcomes.

Clinical authority and judgement will be exercised according to the scope of the degree held by the employee. Additional clinical supervision will be provided through group peer clinical case reviews and indirectly under the leadership of those clinically credentialed on the Medical Management Team.

This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as required. This position is required to reside in North Carolina

Responsibilities & Duties

Manage and Develop Staff

• Work with Human Resources to attract, 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
• Provide direct clinical support and administrative supervision of team members. This may include routine review of cases, interpretation of census data, and advising team members regarding outreach to network providers regarding cases where care teams are engaged
• 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
• Actively monitor member engagement, care managers productivity and adherence to member contact requirements
  
  

Oversee Department/Unit Operations

• Collaborate across the care management division to ensure a cohesive and well-coordinated approach to whole person care is achieved for the members served and for the staff working within the department
• Incorporate all DMH and DHB Tailored Plan (TP) and applicable waiver program contractual requirements related to care management for individuals identified as having specialty behavioral health care needs
• Incorporate knowledge of Alliance health benefit plans and cross departmental structure to help guide efforts of care teams in supporting members with service engagement, assessing impact and seeking resolution of disparities regarding social determinants of health, monitoring census risk stratification for changes that will impact overall management of cases served
• Monitor program dashboard and respond to risks identified
  
  

Develop Policies, Procedures, Processes, and Workflows

• Use a population health management approach when developing policies, procedures and workflows which impact the work of the department
• Collaborate with other care management leadership and Medical Management team on development and implementation of clinical decision making workflows
• Ensure adherence to care management policies and procedures
• Assist in the development of applicable waiver specific workflows, policies and procedures
  
  

Collaborate with Internal Departments and External Stakeholders

• Analyze population health trends and collaborates with Medical Management on interpretation and business action steps associated with deductions drawn
• Develop workflows and collaborates across Alliance departments to understand data from a variety of sources as this relates to the physical health care risk and need for support of members served
• Represent the Community Care Management program in Network provider related performance discussions to ensure agreement of desired outcomes across care team, CMA and AMH care management models
  
  

Minimum Requirements

Education & Experience

Master's degree in mental health, public health, social work, psychology, education, sociology, or health administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work, or education, including three (3) years of supervisory, consultative or administrative experience. Must have demonstrated experience overseeing care management programs for individuals with intellectual and developmental disorders, and experience overseeing care management programs for individuals served under a Home and Community Based Services waiver.

Or

Bachelor’s degree in mental health, public health, social work, psychology, education, sociology, or health administration from an accredited college/university and seven (7) years of experience in a community, business, or governmental program in health-related fields, social work, or education, including three (3) years of supervisory, consultative or administrative experience. Must have demonstrated experience overseeing care management programs for individuals with intellectual and developmental disorders, and experience overseeing care management programs for individuals served under a Home and Community Based Services waiver.

Preferred: Clinical license, CCM Certification

Knowledge, Skills, & Abilities

• Thorough knowledge of the care needs for individuals with intellectual/developmental disabilities, traumatic brain injury, mental health, and/or substance use disorders
• Thorough knowledge of whole person care and population health approaches to care management
• Proficient with Microsoft Office products and knowledge of data analytics programs and reporting
• Strong oral and written communication skills
• Problem-solving and Program analysis skills
• Change Management skills
• Exceptional interpersonal skills
• Detail oriented, able to independently organize multiple tasks and priorities
• Ability to effectively manage under pressure of deadlines
• Ability to build and maintain positive relationships with internal and external customers and stakeholders.
• Knowledge of quality improvement processes
• Conflict Resolution skills
• Knowledge of Care Transitions-discharge planning
  
  

Salary Range

$116,926-$149,080/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