Tailored Care Manager

The Tailored Care Manager (TCM) plays a key role in North Carolina's Medicaid Tailored Plan Care Management model by coordinating physical health, behavioral health, pharmacy, and social support services for individuals with complex needs. The TCM ensures members receive person-centered, whole-health care that promotes stability, recovery, and improved quality of life.

The position is funded and guided by NC DHHS Tailored Plan Standards and Alliance Health Care Management Guidelines, and requires active collaboration across providers, clinical consultants, hospitals, DSS, courts, and natural supports.

Key ResponsibilitiesComprehensive Assessment & Planning

• Conduct and document Care Management Comprehensive Assessments (CMCAs) and reassessments at required intervals, in accordance with NC Tailored Plan standards.
• Develop Individual Support Plans (ISPs) and Transition Plans that reflect the member's goals, needs, strengths, risks, and service preferences.
• Ensure all care plans are person-centered, culturally competent, and updated upon significant change or transition.

Care Coordination & Monitoring

• Lead interdisciplinary team (IDT) meetings involving the member, family, clinicians, and other supports.
• Coordinate across physical health, behavioral health, pharmacy, and social service systems.
• Facilitate communication between providers to ensure appropriate, timely, and high-quality services.
• Monitor utilization, adherence, and progress toward ISP goals through regular contact with the member and providers.
• Identify barriers to care (e.g., transportation, housing, access to medications) and develop solutions.

Transition Management

• Coordinate care transitions from hospitals, residential treatment, or correctional facilities to community settings.
• Complete and document Transition Plans within required timeframes per DHHS and Alliance policy.
• Ensure warm handoffs, medication reconciliation, and follow-up appointments.

Engagement & Outreach

• Establish trust and rapport with members through ongoing, strengths-based engagement.
• Educate members and families about service options, self-management, and community supports.
• Collaborate with Peer Support Specialists, Family Partners, and Clinical Consultants to promote recovery and resilience.

Documentation & Compliance

• Maintain timely, accurate documentation in the electronic health record (EHR) per Alliance and NC DHHS standards.
• Utilize evidence-based screening tools and standardized assessments as required.
• Participate in utilization reviews, quality audits, and performance improvement initiatives.
• Comply with confidentiality and HIPAA standards at all times.

QualificationsMinimum Requirements

• Must meet Qualified Professional (QP) criteria as defined in 10A NCAC 27G .0104.
• Bachelor's or master's degree in a human services field (social work, psychology, counseling, nursing, or related).
• Minimum 2 years of post-degree experience providing care coordination, case management, or clinical services for individuals with behavioral health or intellectual/developmental disabilities (I/DD) needs.
• Experience working within Medicaid or managed care systems preferred.

Preferred Qualifications

• Licensed or provisionally licensed clinician (LCSW, LCMHC, LMFT, LPA, RN, LCAS) or advanced degree in a behavioral health discipline.
• Certification or training in Tailored Care Management, Person-Centered Thinking, Motivational Interviewing, or Trauma-Informed Care.
• Experience coordinating care across systems (behavioral health, DSS, justice, primary care, housing, and employment).
• Strong organizational and time management skills; ability to balance fieldwork and documentation.

Additional Requirements

• Must possess a valid North Carolina driver's license and reliable transportation.
• Ability to work flexible hours to meet member needs, including occasional evenings.
• Must pass background and drug screening per agency policy.

Job Type: Full-time

Pay: $ $24.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Experience:

• care management: 1 year (Required)
• coordinating behavioral health services: 1 year (Required)
• serving individuals with complex needs: 1 year (Required)
• developing individualized service plans: 1 year (Required)

Work Location: In person