Remote Concurrent Review Nurse Jobs in Raleigh, NC

The Facility Based Care Managers Supervisor provides oversight to the Facility Based Care Managers, a team of licensed and non-licensed staff who provide or assist with the provision of Transitional Care Management for members with physical and/or behavioral health needs in Acute Care facilities, State Operated Developmental Centers, and Justice System settings. 

This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices for business or onsite team meetings as needed. Weekly provider site visits may be required within local area. 

Responsibilities & Duties-

Supervise and Develop Staff

• Work with Human Resources and Unit Director 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, business processes and workflows
• 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

Supervise Unit Operations

• Participates 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

Provide Customer Service

• Develop strong working relationships with providers and internal/external stakeholders by scheduling ongoing opportunities to share feedback and collaborate
• Exercise conflict resolution skills to appropriately resolve issues with providers and internal/external stakeholders
• Develop strong working relationships among the department and provide customer services with providers and stakeholders internal/external by scheduling ongoing opportunities to share feedback and collaborate

Quality/Data/Analytics

• 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

Compliance with Alliance Policy and Procedure

• Ensure adherence to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

Continuous Quality Improvement

• Make recommendations to improve department procedures and increase operational efficiency
• Monitor trends and identify opportunities for enhancements in service utilization and implementation throughout the organization

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

Required:

Graduation from an accredited school of nursing with Registered Nurse license and five (5) years of 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.

Or

Master’s degree in human services from an accredited college or university and three (3) years post graduate degree experience with at least two 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 a valid, active clinical license as a LCSW, LMFT, LCAS, LCMHC, LPA, or RN in North Carolina. 

Preferred: 

Two (2) years supervisory experience and CM or CCM certification preferred.

Knowledge, Skills, & Abilities-

• Knowledge and understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and ICD-10 coding
• 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 1915(b) and NC Innovations Waiver
• Knowledge of Medicaid and Innovations Service Array
• Knowledge of applicable Federal laws, including Substance Abuse and HIPAA Privacy Laws.
• Knowledge of National Accreditation standards and regulations
• 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 

$79,425-$101,267/Annually 

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