Manager-Transition of Care (Full time Remote, North Carolina Based) (Biotech)

The Manager-Transition of Care oversees a group of Transition Coordinator Supervisor I and II roles. As the leader of the supervisory team, the Manager-Transition of Care, supports the Transition Coordinator Supervisors in ensuring that our Transition Coordinator/Physical Health teams are preforming efficient and contract compliant Transitional Care Management in Acute Care Facilities, State Developmental Centers, and Jails.

This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings at Alliance offices may be required. 

Responsibilities & Duties

Staff Management and Development

• Work with Human Resources and Director of Transition of Care 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 for Tailored Plan Implementation
• 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

Collaborate with External, and Internal Stakeholders

• Develop strong working relationships with departmental leadership of external stakeholders such as inpatient hospitals, emergency departments, crisis centers and Jail  
• Develop strong working relationships within Provider Networks and Provider Network Evaluation to ensure capacity needs are met for members

Implement Recommendations for Continuous Quality Improvement

• Review, validate and interpret risk stratification data and population health groups and recommends 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
• Participate in the initiation, development, and maintenance of clinical protocols and other population-based programs, facilitating collaboration and consensus of multidisciplinary teams as complete care is developed
• 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, case management and plans of care

Oversee Documentation Maintenace and Reporting 

• Maintain medical record compliance/quality
• Ensure timely documentation of Care Coordination activities as required by department policy and procedures
• Ensure timely documentation of Warm Handoff Summaries and other communications to Provider Led Entities and other Health Plans 
• 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

• Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

Travel 

• Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance sponsored events, etc may be required
• Travel to meet with members, providers, stakeholders, attend court hearings etc. is required

Minimum Requirements

Education & Experience

Bachelor's degree from an accredited Nursing program with six (6) years post graduate degree experience with at least two (2) years of applicable experience with the population served, including experience with case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care.  Must have two (2) years supervisory experience. 

Or

Master's degree from an accredited college or university in Human Services and four (4) years post graduate degree experience with at least two (2) years of applicable experience with the population served, including experience with case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care. Must have two (2) years of supervisory experience. 

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

Preferred: ACM or CCM certification

Knowledge, Skills, & Abilities

• Knowledge and understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and ICD-10 coding
• Knowledgeable of the Tailored Plan and Medicaid Direct Transformation
• Considerable knowledge of the MH/SUD/IDD service array provided through the network of the Applicant's providers. 
• Knowledge in the implementation of the 1915 (b/c) waivers and national accreditation is essential
• 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 Utilization Management/Utilization review and other related areas
• 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 Medicaid and Innovations Service Array
• 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

Salary Range

$86,800 -$110,670/ 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

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

Education

Required

• Bachelors or better in Nursing

Licenses & Certifications

Required

• Driver License

Preferred

• Lic Clinical MH Counselor
• Lic Clinical Social Wkr
• Lic Marr & Family Ther
• Lic Psychological Assoc
• Registered Nurse

See job description