Alliance Health

Support HR operations including data management, employee offboarding, and documentation in a remote setting. | High school diploma with 2+ years of administrative experience, familiarity with HCM systems preferred, strong organizational and communication skills. | The Human Resources (HR) Coordinator provides administrative and operational support to the Human Resources team, ensuring smooth and efficient HR processes. This position will support operations of the HR Department including administrative tasks, licensure/certification monitoring, employee offboarding and assisting with employee data management in the Human Resource Information system (HRIS). This position is primarily full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for HR needs and other onsite meetings as required. Responsibilities & Duties Monitor and Process Information in UKG • Process supervisor changes and other requested changes in UKG • Monitor current license/certification submissions in UKG to ensure all needed information is included, primary source verification has been conducted, and documentation has been uploaded to Document Manager • Monitor license/certification expirations and provide notification to HR leaders of any approaching expirations with no action • Process name changes in UKG, ensure appropriate documentation is obtained and collaborate with IT on needed email changes • Process and monitor assigned requests in People Assist • Add files as needed in Document Manager • Assist with reporting as needed Offboarding • Process employee terminations in UKG, ensure all appropriate staff are notified and offboarding information is provided to the employee and supervisor • Launch exit surveys through UKG and schedule individual exit surveys prior to last day of employment General HR • Manage HR Internal email box, respond to or route emails appropriately • Assist employees with basic HR-related issues and direct complex concerns to the appropriate HR team member • Handle employment verification requests including electronic submission and creating letters • Assist with documentation creation/formatting/updating • Assist with gathering needed information and processing contracts and purchase orders for HR • Assist with HR Grid page maintenance • Maintain organizational chart adding new hires, new positions, and removing terminations • Assist with set up of meetings, scheduling dates/times, room reservations and room set up • Assist with gathering needed information for audits • Assist with other administrative tasks and projects as needed to ensure the smooth operation of the HR department Minimum Requirements Education & Experience Required: High School or equivalent and two (2) years of administrative experience with a focus on Human Resources. Experience in customer service, data entry, and working in a HCM system to add and process information required. Preferred: Experience working in Human Resources for State or Local Government in North Carolina Knowledge, Skills, & Abilities • Knowledge of Human Capital Management systems • Microsoft Office Suite Skills • Verbal and written communication skills • Organizational skills and attention to detail • Interpersonal and conflict resolution skills • Time management skills with a proven ability to meet deadlines. • Ability to act with integrity, professionalism, and confidentiality within a high-paced and at times stressful environment. Salary Range $25.75-$33.48/Hourly 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

Perform utilization reviews and management of behavioral health services to ensure appropriate and economical care delivery under Medicaid and state programs. | Master's in Human Services or psychiatric nursing with active clinical license in NC and 5+ years behavioral health experience, preferably in utilization management. | The UM Clinical Specialist-Behavioral Health performs professional and administrative work, primarily utilization reviews, utilization management and active care management to ensure economical and effective consumer service delivery by PHIP enrolled network providers; The position is responsible for providing medical necessity reviews of individualized service plans and requests for authorization of services to ensure consumers receive services in the least restrictive, most integrated setting appropriate to the individual’s needs; The primary role is to review for services under the Medicaid B waiver and state funded benefits; complete related work as required. 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 come into the Alliance Office for business and team meetings as needed. Responsibilities & Duties Utilization Reviews and Management • Independently conducts medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times • Conducts utilization reviews to monitor adherence to clinical practice guidelines and best practice standards and to determine if services were delivered as requested • Engage in care management activities to ensures individuals receive appropriate referral for treatment including; consumer and provider follow-up calls, case staffing with psychologists and medical staff • Monitors consumer person centered plans to ensure that effective treatment interventions are utilized, provide consultation to treating providers when person centered plan requires adjustments to better meet consumer needs • Monitors and reports consumer and provider specific over/under utilization • Conducts utilization reviews to monitor for over/under utilization Program Operation and Management • Identify high risk consumers and those with special health care needs for referral to Care Coordination and case escalation • Provides linkage, authorizations and level of care determinations, assisting providers and Care Coordinators with creative problem solving to recommend alternative approaches to care • Ensures compliance with care management and quality improvement policies and procedures, utilization review laws and regulations, state standards • Promote access to appropriate, effective and quality treatment • Monitors for undesirable performance or deviations of practice standards through care management activities that may have a negative impact on consumers. Responds through additional follow-up with consumer and providers, provider technical assistance and/or referral to other departments within the MCO Administrative Functions • Notifies members of adverse benefit determinations while preserving members’ Due Process rights • Engages in routine follow-up to ensure consumers are engaged in treatment and services are being delivered as requested • Documents utilization review decisions in computerized authorization management system • Maintain professional licensure • Engages in training as needed to stay informed of changes in best practice for supporting the needs of individuals with MH/SUD/IDD Minimum Requirements Education & Experience Required: Master’s degree in a Human Services field (such as Psychology, Social Work or Counseling) and at least five years of post-degree progressive experience providing similar services to the population served (MH/SUD). Requires current and active license issued by a North Carolina Professional Board, as a LCSW, LCAS, LP, LPA, LMFT, LCMHC or RN. OR A master's degree in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform this work; or graduation from a State accredited school of nursing and two years of experience in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform the work; or an equivalent combination of education and experience. Preferred: Experience in the public behavioral healthcare field is highly desired due to the complexity of the work. Experience in a UM environment in Behavioral Healthcare would be valuable for this employee. Knowledge, Skills, & Abilities • Considerable knowledge of case management principles, practices and applications • Considerable knowledge of agency and community programs and services which affect clients and applicants • Knowledge of state and federal client rights protection statues and regulations applicable laws and regulations including but not limited to URAC, applicable Code of Federal Regulations and NC Administrative Code • Effective written and oral communication skills and interpersonal and presentation skills • Ability to identify rights protection complaint issues; ability to set, monitor and evaluate standards for quality and to assess plans to measure how they meet the needs of individual clients • Considerable knowledge in DMS 5 diagnostic criteria • Ability to manage time, prioritize work and use problem-solving approaches • Ability to coordinate effectively with staff from a various agencies as well as inter-departmental • Ability to read, analyze, and interpret regulations, policies and procedures • Coordinate work with a variety of individuals and agencies • Ability to operate computer equipment and generate reports and records; ability to express ideas clearly and concisely orally and in written documents • Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required Salary Range $68,227 - $86,990/Annual 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

Lead strategy, oversight, and performance of physical health care management programs ensuring quality, compliance, and stakeholder collaboration. | Bachelor's degree in nursing with RN license, 7 years experience including 5 years supervisory in clinical/non-clinical management, preferably with Medicaid Managed Care experience. | The Sr Director-Physical Health is a senior leadership role responsible for the strategy, oversight and performance of the physical health care management programs. This position ensures that care management services deliver high quality, cost-effective care, improve health outcomes, and adhere to state and federal regulations, payer contracts, and internal policies and procedures. Reporting to SVP-Care Management, this position will participate in strategic planning as a member of the Clinical Operations senior leadership 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. Responsibilities & Duties Program Leadership and Strategy • Develop, implement and continuously refine a strategic vision for the physical health care management programs in line with organizational goals • Lead long-range planning to anticipate future developments (regulatory changes, Medicaid Managed Care evolution, payment model shifts, etc.) that impact physical health care management • Lead quality improvement initiatives with the use of data and analytics to identify gaps in care or process inefficiencies and implement corrective action • Develop strategies for reducing avoidable hospitalizations, readmissions, improving preventive care uptake • Serve as liaison with external stakeholders such as payers, state agencies, provider networks, regulatory bodies, community partners • Ensure that member experience is central to care management efforts Program Development and Oversight • Oversee care coordination and care transitions programs to ensure smooth transitions across care settings (hospital to home, specialist to primary care, plan to plan) • Oversee Care Management programs for high-risk populations (pregnant women, children, people needing LTSS, individuals with chronic conditions) • Collaborate across the Clinical Operations Division to promote integrated care and address social drivers of health • Manage budget, resources and staffing for physical health care management department • Recruit, train, mentor and develop care management teams including clinical managers, case managers and front-line staff Regulatory and Compliance • Accountable to oversee the development of new and maintenance of existing training, desk references, workflows, and other tools to support CM physical health operations related to policies and procedures • Responds to new or changes to regulatory requirements to ensure policies and operational procedures align, are revised, or created to reflect regulations Program Leadership and Strategy • Develop, implement and continuously refine a strategic vision for the physical health care management programs in line with organizational goals • Lead long-range planning to anticipate future developments (regulatory changes, Medicaid Managed Care evolution, payment model shifts, etc.) that impact physical health care management • Lead quality improvement initiatives with the use of data and analytics to identify gaps in care or process inefficiencies and implement corrective action • Develop strategies for reducing avoidable hospitalizations, readmissions, improving preventive care uptake • Serve as liaison with external stakeholders such as payers, state agencies, provider networks, regulatory bodies, community partners • Ensure that member experience is central to care management efforts Minimum Requirements Education & Experience Bachelor’s degree in nursing with RN license and seven (7) years of experience with the population served, including five (5) years of supervisory, consultative, and administrative experience managing clinical and non-clinical resources/business areas. Must have demonstrated experience leading and managing a broad and diverse business operation. Preferred: Health Plan Managed Care experience highly preferred. Knowledge, Skills, & Abilities • Proven record of working with NC Medicaid Managed Care programs • Demonstrated ability to integrate physical and behavioral health, social services, and pharmacy services • Strong knowledge of NC Medicaid policy and regulatory requirements • Excellent data analytics skills; ability to turn data into actionable insights • Leadership, change management and ability to lead across silos • Financial acumen, budget planning and cost-benefit analysis Salary Range $135,630-$172,929/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 Education Required • Bachelors or better in Nursing Licenses & Certifications Required • Registered Nurse Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.