Remote Hcc Risk Adjustment Coder Jobs in North Carolina

The Care Management Consultant is a highly trained and experienced Clinician working in a consultive role and providing secondary Case Management as part of Alliance’s Multidisciplinary Care Management Team for members with Physical Health needs.   The Care Management Consultant offers on-demand recommendations, provides Physical Health related education within their scope of licensure, completes Medication Reviews, and escalates review of complex cases to Medical Directors and/or Pharmacists as necessary, to optimize health outcomes for the member.

This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices for onsite team meetings as needed.

Responsibilities & Duties

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 escalate 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

Minimum Requirements

Education & Experience

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.

Knowledge, Skills, & Abilities

• 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.

Employment for this position is contingent upon a satisfactory background, which will be performed after acceptance of an offer of employment and prior to the employee's start date. 

Salary Range 

$68,227-$86,990/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