Alliance Health

General

• Oversee the development, implementation, and support of EDI systems, processes and vendor interactions
• Collaborate with cross-functional teams, manage EDI projects, and ensure seamless electronic data exchange with partners and customers
• Lead and manage the EDI development and support team, providing guidance, mentorship, and technical expertise
• Oversee the design, development, and implementation of EDI solutions
• Collaborate with IT, operations, and business analysts to gather requirements
• Manage EDI projects from initiation to completion
• Coordinate with external trading partners to establish EDI connections
• Develop and maintain EDI maps, transformations, and data mappings
• Ensure the reliability, availability, and security of EDI systems
• Provide technical expertise and support to resolve complex EDI-related issues
• Prepare and present regular reports and updates to IT management

Manager, EDI Development and Support

Manager

• Assures that individuals and families with special health care needs receive integrated whole-person care management
• Coordinate across physical health, behavioral health, pharmacy, and unmet health-related resource needs
• Link to services and supports to maximize outcomes and decrease unnecessary use of hospitals
• Collaborate with community systems to support the identified population
• Complete comprehensive assessments or Care Needs Screening at enrollment, yearly or at changes in condition
• Develop Plans of Care derived from the completed assessments
• Assign interventions/plans of care to applicable Alliance Care Management team member
• Submit referrals to the Transition Support Team when necessary
• Assist individuals/legally responsible persons in choosing service providers
• Evaluate appropriateness of services and ensure implementation of plan of care
• Utilize person centered planning and motivational interviewing to gather information
• Schedule initial contact with member for assessment and engagement
• Verify accuracy of demographic information and schedule meetings with member/guardian
• Provide education and support to individuals and LRP
• Recognize and report critical incidents and provider quality concerns

Care Manager I – Non-Waiver

• Manage The Classification and Compensation Plan
• Manage the Pay Structure to ensure job classifications and salary levels are captured accurately and are up to date
• Manage the administration of the compensation system to ensure consistent and equitable compensation among positions, monitor the effectiveness of existing compensation practices and recommend changes that are cost-effective and consistent with compensation trends within the industry and organizational objectives
• Manage compensation studies and salary surveys under the guidance of the Director of Talent Acquisition and Compensation to ensure accurate and timely information is shared and recommendations are in line with organization objectives
• Ensure compliance with federal, state, and local compensation laws, regulations, and contracts
• Conduct salary reviews to ensure the organization is competitive with market trends
• Advise staff on pay decisions, policy interpretations, and job evaluations
• Manage the maintenance of all relevant tracking and reporting systems to accurately capture the flow of relevant data being processed by the team
• Manage the Creation of New Jobs and Positions and Manage Changes to Existing Jobs and Positions
• Collaborate with Department leadership on creation of new jobs and departmental structure changes
• Assist leaders with the development of job descriptions for each job in the organization, ensuring descriptions accurately reflect the work being performed by incumbents
• Manage the job analysis process to determine FLSA classification and salary level for each job in the organization
• Ensure jobs are classified and leveled appropriately based on the specifications of the job
• Develop and Maintain Compensation Policies, Procedures, Programs, and Workflows
• Design creative solutions to specific compensation-related programs and incentive plans
• Assist with the development and maintenance of compensation policies and procedures
• Analyze and refine desk procedures and workflows to improve department operations
• Develop written guides and presentations to assist in communicating and clarifying the processes, policies, and procedures to leaders and staff
• Manage and Develop Staff
• Work with the Senior Director of Human Resources to recruit and retain a highly qualified and well-trained Classification and Compensation team
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• 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 for all team members
• Work to resolve conflicts and disputes among team
• 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 partnerships
• General HR
• Manage the handling of and responses to relevant cases submitted to the HR case management system
• Manage HR records according to area of responsibility by ensuring files are updated, accurate and properly documented in accordance with recordkeeping requirements
• Ensure employees and leaders have appropriate training and materials to assist with processes related to area of responsibility
• Assist in developing, implementing, and administering relevant HR programs and initiatives that meet current needs while also anticipating future business and talent trends

Manager – Classification and Compensation

Executive Assistant

• Provides direct administrative support to the Chief Innovation and Strategy Officer
• Manages the administrative functions for the Innovation and Strategy Division
• Interacts routinely with all levels of Alliance leadership and staff
• Set work priorities
• Resolve problems and conflicts using initiative and judgment
• Order and track supplies for the Division
• Track P card expenditures, maintain documentation, and prepare and submit monthly report
• Liaise with Facilities department on work space and maintenance issues
• Liaise with vendors as needed
• Make travel arrangements for Division personnel
• Review and route correspondence to appropriate individuals for preparation of replies
• Draft, edit, and disseminate letters, memos, and other documents
• Manage and maintain details for the CISO
• Streamline division office procedures and workflows
• Maintain functionality of copier/scanner

Executive Assistant I – Innovations

Account Manager

• The Employee Relations Manager provides responsive customer service to Alliance employees in all areas of Human Resources
• Manage employee disciplinary process to ensure applicable procedures are followed and documentation is appropriate, accurate and timely
• Manage employee complaint and grievance processes in accordance with applicable procedures, conduct investigations as required and handle associated appeals through to closure
• Partner with Benefits as needed on complex ADA cases
• Conduct mediations and/or facilitated conversations to help resolve conflict
• Assist in legal matters related to employee relations to include information gathering, investigations and representing Alliance at related hearings when needed
• Work closely with Legal Department on review of various actions such as dismissals, approved/denied accommodations and other sensitive matters to ensure proposed actions are legally defensible
• Lead performance management efforts including monitoring employee and leader progress throughout the performance review and goal planning cycles
• Provide HR communications regarding timeline and process to keep employees informed and develop resources and trainings to assist in the processes
• Provide updates and data as requested to HR leadership
• Review, research, and assist in policy development and modification, and draft policy recommendations ensuring updated laws/regulations are included
• Provide guidance to employees with policy/procedure interpretation and ensure they are followed appropriately
• Work with the Director of Human Resources to recruit and retain a highly qualified and well-trained workforce
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• 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

Manager, Employee Relations

Administrative Assistant

• Provide Front Desk Support
• Answer telephones, direct calls, and take messages
• Greet, welcome, and assist visitors appropriately
• Notify staff promptly of visitor arrival and coordinate visitor access
• Communicate with customers, employees, and other individuals to answer questions
• Open, sort, and route incoming mail and packages
• Prepare outgoing mail and packages
• Maintain the mail room in an organized, clean, and functional condition
• Operate office machines such as copiers, scanners, voice mail systems, and computers
• Support teleworking staff as needed through email and Microsoft Teams
• Assist with Facility Needs and act as a liaison to the Facilities Manager

Administrative Assistant I – Legal

• The Care Manager l-TCL assures that individuals and families with special health care needs receive integrated whole-person care management, including coordinating across physical health, behavioral health, pharmacy and unmet health-related resource needs to ensure they are linked to services and supports in an effort to maximize potential outcomes and decrease the unnecessary use of hospitals and emergency services by assuring that appropriate quality care is in place.
• The Care Manager I – TCL focuses on a specified population of members utilizing health care services while ensuring all member health needs and referrals are attended to.
• The Care Manager l will collaborate with other community systems to work in partnership to support the identified population while working to assist member with remaining in their preferred housing per Transition to Community Living requirements.
• 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
• 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

Care Manager I – TCL

• Administer and coordinate physical health utilization management activities
• Ensure the UM Department operates as an integrated department
• Oversee the correct level and intensity of services for individuals
• Manage and develop staff to maintain a qualified workforce
• Collaborate with the Director of Behavioral Health Utilization Management

Director – Utilization Management, Physical Health

Affiliate Manager

• Lead the delivery of a comprehensive, blended new hire orientation experience
• Support employees from their first day through the initial six weeks of employment
• Responsible for the design and execution of early-stage onboarding
• Enhance, improve and own the new employee buddy program
• Collaborate with supervisors to develop new hire training plans
• Partner with cross-functional teams to create, implement, and deliver a seamless onboarding experience
• Regularly monitor key indicators to evaluate and improve the employee experience
• Maintain oversight of the orientation schedule and logistics
• Lead onboarding communications

Learning Business Partner II – Employee Development

• Lead communication among care team members and serve as the primary point of contact for the member served
• Complete comprehensive assessments at enrollment, yearly or at changes in condition
• Develop Plans of Care derived from the completed assessments
• Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities
• Submit referral to the Integrated Health Consultant
• Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs
• Schedule initial contact with member to verify accuracy of demographic information
• Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues

Care Manager II

Community Manager

• Provides critical support to Alliance members with I/DD to successfully integrate from an institutional setting into independent community living settings of their choice.
• Building relationships and rapport with members and providers through in-reach activities.
• Ongoing support transitioning into the community, and care management once in the community.
• Additional diversion planning and coordination for members to ensure success in community living.
• Hybrid role requiring both facility visits and home visits to meet member needs.
• Travel monthly throughout North Carolina to meet with members, providers, and/or state developmental centers.

I/DD Community Integration Care Manager

Vice President

• Provides senior leadership for Alliance Health’s operational capability to integrate social care, physical health, behavioral health, and community-based supports for Tailored Plan members
• Leads implementation of social care and community integration priorities
• Coordinates internal teams, works with participating providers, and community partners to provide integrated, community-based services for our members with complex needs
• Develops and executes Alliance’s enterprise SDOH strategy
• Advises the CEO, CMO and Board of Directors on SDOH priority areas
• Leads systemwide health equity, community engagement, and social care transformation initiatives
• Leads all SDOH initiatives including housing stability programs and care coordination
• Oversees budgets, contracts and performance measures related to SDOH programming
• Serves as the executive leader accountable for all organizational obligations related to the TCL Settlement
• Oversees implementation strategies that expand permanent supportive housing
• Ensures all SDOH initiatives comply with NCDHHS Tailored Plan standards
• Oversees development of SDOH analytics and predictive models
• Leads and develops multidisciplinary teams across SDOH, housing, equity, community engagement, and care integration

SVP, Community Health and Integration

• Provides critical support to Alliance members with I/DD to transition from institutional setting to independent community living.
• Building relationships and rapport with members and providers through in-reach activities.
• Ongoing support during transition into the community and follow-up once in the community.
• Additional diversion planning and coordination provided for success in community settings.
• Requires facility and home visits to meet member needs.
• Travel monthly throughout North Carolina to meet with members, providers, and/or state developmental centers.

Community Integration Care Manager

• Provide episodic support roles to the members’ multidisciplinary care team.
• Assist with State required assessments.
• Coordinate member follow up care.
• Collaborate with member/guardians and providers to develop discharge plans.
• Facilitate arrangements for and scheduling of transportation, in-home services, and follow-up outpatient visits.
• Conduct post-discharge follow up with member.

Care Manager I – Facility Based

• Provide Transitional Care Management and Physical Health Consultation for members with physical and/or behavioral health needs.
• Active and onsite participation in discharge planning beginning with admission.
• Travel weekly to UNC facilities in Johnston County and Orange County.
• Provide Care Team Support and subject matter expertise regarding member’s physical and/or behavioral health.
• Work collaboratively with other Alliance staff, behavioral health providers, primary care physicians, specialty care providers and other community partners to support members.
• Conduct outreach to the member’s providers and obtain a copy of the discharge plan.
• Assist the member in obtaining needed medications prior to discharge.
• Develop a ninety (90) day post-discharge transition plan prior to discharge from residential or inpatient settings.
• Appropriate escalation of high risk/high visibility and/or complex barriers/needs members.
• Ensure all clinical documentation meet state, agency, and Medicaid requirements.
• Review, validate and interpret risk stratification data and population health groups.