Alliance Health

Manager

• Complete Assessment/Planning
• Complete comprehensive assessments or Care Needs Screening at enrollment, yearly or at changes in condition
• Develop Plans of Care derived from the completed assessments
• Demonstrate commitment to whole person/integrated care
• Assign interventions/plans of care to applicable Alliance Care Management team member to meet identified member needs, for monitoring, and/or service engagement activities
• Submit referrals to the CCM when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity
• Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues
• Assist individuals/legally responsible persons in choosing service providers, ensuring objectivity in the process
• Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification
• Utilize person centered planning, motivational interviewing, and historical review of assessments in JIVA to gather information and to identify supports needed for the individual
• Assist in collecting data to be used to identify and address barriers as well as determine the effectiveness of care management/care coordination in reducing lengths of stay and use of emergency services
• Actively collaborate with members/legally responsible person, care team, service providers, and identified supports to ensure development of a plan that accurately reflects the individual’s needs and desired life goals consistent with best practices and working through the permanent supportive housing model
• Provide Support and Monitoring to Members
• Schedule initial contact with member for purpose of assessment and engagement
• Schedule face to face, virtual, and telephonic meeting with member/guardian to provide education about Alliance Health Plan, care teams, resources, and services
• Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance
• Refer members who are in crisis/institutional setting and require assistance with returning to community-based services to the Integrated Health Consultant or applicable care team member
• Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management Department
• Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment or other assessments as deemed necessary
• Coordinate with other team members to ensure smooth transition to appropriate level of care when needed
• Communicate with member to check on status, verify care needs are met and update the Plans of Care, as needed
• Provide follow up coordination with key stakeholders to promote engagement
• Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues
• Verify that ongoing service adherence is maintained through monitoring meetings with member and/or guardian or provider
• Identify barriers to treatment and assist individuals with arranging appointments or linking to treatment providers
• Maintain required contacts with member/legally responsible person per state contractual requirements meeting minimum expectations
• Attend community, provider, stakeholder meetings as needed for member and/or as directed to support the needs of the health plan
• Complete Documentation
• Obtain and upload all supporting documentation, Legally Responsible Person (LRP) verification, and release of information that will improve care management activity on behalf of the member
• Open new episodes in JIVA when needed and schedule initial contact with member to verify accuracy of demographic information and initiate the rapport building process
• Document all applicable member updates and activities per organizational procedure
• Escalate complex cases and cases of concern to immediate supervisor. Share appropriate documentation with all involved stakeholders as consent to release is granted
• Obtain releases/documentation and provide to all stakeholders involved
• Maintain medical record compliance/quality
• Proactively respond to an individual’s planned movement outside the Alliance geographic area, or other transition need, to ensure a smooth transition without lapse in care.
• Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements
• Compliance with Alliance Policy and Procedure
• Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures TCL
• Ongoing Monitoring
• Complete TCL monitoring requirements as outlined in service desk reference to support member tenancy, health, safety and community integration, property and provider coordination, technical assistance, service linkage, addressing barriers, review the monthly tenancy checklist and routine reporting
• Assist the Post-Transition Engagement Specialist with contact information, as needed, so the 11- month and 24 - month Quality of Life surveys can be completed by their due date
• Tenancy Stability/Rehousing
• Provide support to Community Health and Well-being Supportive Housing team to secure documents required to maintain TCL tenancy, including annual inspections, biannual recertification, income adjustments, and monthly housing checklist, as needed
• Complete and follow up on any voucher application needs
• Provide technical assistance to providers during the re-housing process
• Complete, at minimum, monthly follow up with providers when a member loses TCL housing and requests a rehouse
• Assist provider with completing the required documents for members moving to Bridge or Hotel Program
• Update State and Alliance Health data systems when rehousing is confirmed
• Educate member about Individual Placement and Support-Supported Employment (IPS-SE) for employment referral, community integration and education referral and support
• Housing Separations
• Complete required discharge tasks when member leaves TCL housing
• 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

Care Manager I – TCL

Administration

• The Contract Administrator manages all administrative and procedural components of provider contracts (Medicaid and Non-Medicaid) throughout the contract lifecycle, including but not limited to ensuring compliance with company contract templates, standards, and other key process controls
• This includes implementation, completion and ongoing follow-up of various managed-care contracts, amendments, and other related document for entities within Alliance Health’s integrated delivery system
• Assist in development and maintaining effective relationships with payors and internal stakeholders
• Communicate contract terms and/or facilitate follow up with General Counsel to providers and work with other internal departments to implement improvements in the contracting process
• Manage the full life cycle of provider contracts, including timely preparation of contract documents while giving special attention to language and accuracy, dissemination of contracts to providers within MCO-identified timeframes, follow-up of agreement status to ensure full execution, as well as accurate processing of executed contracts including completing all required organization forms, checklists, and data entry
• Review any modifications, confirm executed contractual terms and conditions meet MCO requirements, and confirm all attachments are complete
• Ensure contract elements are loaded correctly, timely and meet legal and business standards
• Interface with IT Department to ensure data integrity and accuracy of contract details and ensure all required data elements are entered into the Alliance Claims System
• Create the provider profile in accordance with all services the provider is contracted to provide, and ensure all appropriate rates are included; data must be accurate and timely to support claims processing
• Provide guidance and technical assistance to Alliance providers regarding the processing of contracts as well as ongoing resolution of any contract-related issues
• Help to address provider questions and complaints related to contracting issues and engage Provider Network Relations Staff as needed
• Investigate consumer/provider service discrepancies in contract details as requested and report findings
• Organize, maintain and electronically track all contract and related documents
• Ensure the contract database system functions properly to serve Alliance needs and prepare and distribute reports to facilitate planning and maintenance of accurate contract records and files
• Manage contract files per department procedures and participate in development of time-phased plans for renewal of contracts to support anticipated requirements
• Work collaboratively with cross-departmental staff members to ensure contract deadlines are met and resolve contract-related issues
• Establish and maintain strong business relationships with Hospitals, Physician Groups, LIPs and Ancillary providers.

Contract Administrator

Software Engineer

• Design & Develop RESTful APIs
• Build and maintain .NET & .NET Core services using C#
• Apply clean architecture, CQRS, and DDD patterns
• Implement JWT based authentication/authorization
• Optimize performance for large data sets
• Create & Maintain Supporting Applications
• Write console utilities that consume APIs
• Contribute to Angular/TypeScript front ends and legacy MVC/Razor views
• Produce data export/import tools (CSV, TXT, XLSX)
• Leverage GitHub Copilot and VS Code extensions for AI driven code generation
• Conduct peer code reviews and enforce DRY, SOLID, and security best practices
• Write and maintain meaningful unit tests and contribute to team code coverage and quality targets
• Apply AI-assisted coding tools responsibly with validation, review, and secure coding practices
• Follow established organizational architecture standards (Clean Architecture, layered design, CQRS, or equivalent patterns)
• Push code to Azure DevOps Git repos
• Define build/release pipelines (YAML) for automated testing and deployment to IIS/Azure App Service
• Use PowerShell/CLI scripts for environment provisioning
• Develop T SQL stored procedures, functions, and SSRS reports
• Model entities with Entity Framework Core; manage migrations
• Tune queries for high volume operations
• Maintain up to date API Swagger/OpenAPI specs
• Create consumer guides, troubleshooting run books, and onboarding docs in Confluence/SharePoint
• Mentor junior developers on API design and AI assistant usage
• Attend sprint planning, daily stand ups, retrospectives
• Track work in Azure Boards; update status and acceptance criteria
• Conduct static code analysis (SonarQube, etc.)
• Review and remediate OWASP Top 10 findings
• Follow secure development, PHI-safe, and regulatory compliance standards where applicable

Net Application Developer – Full-time

• Lead all communication among care team members and act as the primary point of contact for members served
• Complete comprehensive assessments at enrollment, yearly or at changes in condition
• Develop Plans of Care derived from the completed assessments
• Consistently evaluate the appropriateness of services and ensure implementation of plans of care
• Actively collaborate with care teams, members supported, and service providers
• Complete and upload all supporting documentation related to care management activity

Care Manager II

• SharePoint Development and Administration
• Design, develop, debug, test, deploy, document, and maintain SharePoint solutions
• Use out-of-the-box functionality, as well as custom SharePoint forms and development using SharePoint Framework SPFx
• Implement, deploy, package, and maintain intranet portal site and SharePoint site
• Contribute to the process development and best practice
• Look at new ways to improve resilience, performance levels and supportability
• Keep abreast of technical developments of operational importance to the agency and to participate in developing or setting standards as directed
• Customize SharePoint sites, lists, libraries, and workflows using third party tools and Power Automate to enhance functionality and streamline business processes
• Oversee end to end migrations from SharePoint on premises to SharePoint Online, ensuring a secure, efficient, and seamless transition for users and business processes
• Follow SharePoint best practices in content management and taxonomy
• Participate in the architectural design, development, customization, and integration efforts of solutions involving collaboration, portals, content management, and workflows
• Collaborate with SharePoint leadership, cross functional development teams, and IT stakeholders to gather requirements, design enhancements, and deliver customized SharePoint solutions that support business objectives
• Establish and maintain effective working relationships with all stakeholders
• Develop both technical and end user documentation
• Ensure that applications and related services are documented and kept current
• Provide support and training to end-users, addressing technical issues and enhancing user knowledge of SharePoint features and best practices
• Aid with on-going SharePoint websites/Intranet application maintenance
• Handle support tickets
• Provide training for end users

SharePoint Developer

• Provide oversight and direction to the Practice Transformation Specialists (PTS)
• Help develop the strategy for the PTS team in order for the AMH+ and CMAs to meet members needs and fulfill their CM credentialing criteria
• Work closely with the Sr Director of Payer and Practice Transformation to define the vision of the department based on data patterns and trends, Medicaid requirements and member needs
• Ensure that the Practice Transformation team is performing effectively and efficiently in compliance of all applicable policies and contractual requirements
• Monitor and manage staff productivity and interaction with providers, CIN and internal Alliance staff
• Ensure staff are well trained in Alliance and Practice Transformation policies, procedures, and business processes
• Provide ongoing coaching and mentoring to staff on new technology tools and practices, including change management practices, to support a learning environment to advance team skills
• Propose solutions for practices/health centers to consider in addressing barriers
• Collaborate with internal and external stakeholders by scheduling ongoing opportunities to share feedback and collaborate

Manager – Practice Transformation

Project Manager

• Plan, execute, and finalize projects according to deadlines and within budget
• Form teams of experts for effective project completion
• Document projected resources, dates, and goals
• Generate and manage a timeline and list of tasks and resources
• Develop and maintain cordial relationships with clients and team members
• Manage operation of all assigned projects
• Prepare and present project reports to management
• Conduct regular meetings with team members to discuss project status
• Manage problems within the project team or issues with clients
• Conduct evaluation meetings after project completion

Project Manager I

• The Care Manager l-TCL assures that individuals and families with special health care needs receive integrated whole-person care management
• Complete comprehensive assessments or Care Needs Screening at enrollment, yearly or at changes in condition
• Develop Plans of Care derived from the completed assessments
• Schedule face to face, virtual, and telephonic meeting with member/guardian to provide education about Alliance Health Plan, care teams, resources, and services
• Actively collaborate with members/legally responsible person, care team, service providers, and identified supports to ensure development of a plan that accurately reflects the individual’s needs
• Complete documentation by obtaining and uploading all supporting documentation and release of information that will improve care management activity

• Complete comprehensive assessments or Care Needs Screening at enrollment, yearly or at changes in condition
• Develop Plans of Care derived from the completed assessments
• Demonstrate commitment to whole person/integrated care
• Assign interventions/plans of care to applicable Alliance Care Management team member to meet identified member needs, for monitoring, and/or service engagement activities
• Retrieve and review historical data to better-understand member’s treatment history
• Submit referrals to the Transition Coordinator when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity
• Assist individuals/legally responsible persons (LRP) in choosing service providers, ensuring objectivity in the process
• Utilize person centered planning, motivational interviewing and historical review of assessments in JIVA to gather information and to identify supports needed for the individual
• Actively collaborates with members/legally responsible person, care team, service providers, and identified supports to ensure development of a plan that accurately reflects the individual’s needs and desired life goals

Care Manager I – Waiver

Director

• Provide administrative support to the Managed Care Organization (MCO) Board of Directors
• Serve as primary liaison between the Board, CEO, MCO staff, and community stakeholders
• Exercise judgement and discretion in scheduling meetings
• Maintain records of archived meeting minutes and attendance
• Compile accurate minutes of Board meetings and Board committee meetings
• Process mail for Board members and archive correspondence
• Prepare reports and presentations for the Board
• Schedule and coordinate Board meetings

Clerk to the Board of Directors

Medical Director

• Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care.
• Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services.
• Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards.
• Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service.
• Process adherence to complete timely utilization reviews in Alliance’s UM platform and perform tasks efficiently.
• Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee.
• Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services.

Care Manager I – TCL

Contract Administrator

Net Application Developer – Full-time

Care Manager II

SharePoint Developer

Manager – Practice Transformation

Project Manager I

Care Manager I – TCL

Care Manager I – Waiver

Clerk to the Board of Directors

Medical Director – Physical Health