Alliance Health

The In Reach and Engagement Specialist provides an essential function of the Transition to Community Living (TCL) program by supporting members with information about, and assistance with, accessing services and community resources to improve the individual’s health outcomes and aid in successful community living. The In Reach and Engagement Specialist also supports MCO efforts through a combination of activities with various public and private agencies, development of processes and agreements to address critical community needs of individuals participating in TCL, and foster relationships and partnerships to aid in the identification and referral to Alliance of individuals that meet special needs or high-risk criteria.  This position is also responsible for administering key assessments to help determine community needs and working in collaboration with several internal teams. This is a full-time hybrid position. The selected candidate must be available to attend onsite...

The Care Manager II position leads all communication among care team members and is the primary point of contact for the member served.  The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices for business or onsite team meetings as needed. Occasional provider site visits may be required within local area Responsibilities & Duties- Complete Assessment/Planning 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 when a physical...

The Practice Transformation Specialist (PTS) works with Advanced Medical Homes (AMH+) and Care Management Agencies (CMA) in the Alliance Health region to improve quality of care. This position serves as a consultant to provider practice staff to improve patient outcomes by enhancing skills in process improvement, team-based care, encouraging patient engagement, sharing identified practice population trends, and analyzing quality data and performance measurements. The Practice Transformation Specialist also collaborates with the Alliance Health Clinical Operations team in the development, implementation, and optimization of training materials used to facilitate practice transformation in the Alliance Provider Network. The Practice Transformation Specialist works with Clinically Integrated Networks to advance provider-p-led care management toward alternative payment models. This position will allow the successful candidate to work a schedule that will be primarily remote....

The Complex Case Manager will engage, and support members with the highest complexity, including multiple chronic conditions, severe mental illness (SMI), substance use disorder (SUD), intellectual/developmental disability (I/DD), mobility impairments, frequent emergency department (ED) and inpatient utilization, and social complexity. The role also requires periodic onsite visits with members in hospital and/or residential settings. There is no expectation of coming into the office routinely, however, the selected candidate must be available to report onsite to the Alliance Office for business meetings as needed.  In addition, you will travel weekly to meet stakeholders within either Harnett/Johnston or Wake/Durham counties, depending on your home location. Therefore, you must reside within a 40-mile radius of these served catchment areas.   Responsibilities & Duties Initial Member Engagement  Contact the member, the member’s authorized representative,...

The Provider Support Line Specialist handles calls from providers and answers questions about joining the network, contracts, enrollment, billing, member information, navigating the EHR, claims submissions, authorization requests, onboarding into our network, troubleshooting various technology platforms, and NCTracks The Provider Helpdesk is open Monday through Saturday 7AM to 6:30PM,  Employee schedules may vary to cover the Helpdesk and will include working holidays. Responsibilities & Duties Provide coverage of the Provider Network Helpdesk phone within Department expectations Guide providers through process of initiating credentialing during times of network expansion Assist providers in navigating the EHR and other portal platforms Respond to requests for information in writing and over email Assist providers in navigating the provider handbook, the Alliance website, forms lists, and other resources...

The Care Manager II position leads all communication among care team members and is the primary point of contact for the member served.  The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This is a full-time remote opportunity. There is no expectation of coming into the office routinely, however, the selected candidate must be available to report onsite to the Mecklenburg Office (Charlotte, North Carolina) for business meetings as needed. The successful candidate will also be required to travel as needed throughout Mecklenburg and surrounding counties to meet with members, providers and/or other community stakeholders. Responsibilities & Duties- Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments...

The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination. This position is primarily remote, with occasional on-site attendance as needed. Candidates residing in North Carolina or willing to relocate are strongly preferred; however, candidates seeking to remain out of state, preferably within the Eastern Time Zone, may be considered on a case-by-case basis. Weekend and holiday work may be required based on operational needs. Responsibilities & Duties Clinical Oversight & Medical Review Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate...

The Actuarial Associate will analyze and interpret data related to cost, membership, capitation, Rate-setting, Incurred But Not Reported (IBNR) and other items as needed.  They will use SQL/excel etc. to model data and assess financial risk and help develop exhibits to assist in the socialization of financial outcomes.   The Actuarial Associate will also serve as a subject matter expert to internal and external stakeholders and partner with teams to produce actionable insights. This position is a remote position, working from home and coming into the office occasionally for in-person meetings with leadership and/or team members. This position is fully remote. The selected candidate must reside in North Carolina.    Responsibilities & Duties  Risk Assessment and Modeling Evaluate information to determine the potential risks of certain events and their financial impact on the organization PMPM Development / Monitoring - Analyze actual vs...

The High Priority Reentry Peer Support Specialist responsible for providing re-entering individuals with Serious Mental Illness (SMI) and/or Severe and Persistent Mental Illness (SPMI), who are on the Department of Adult Correction (DAC) prioritization list, with education and support throughout the transition process.  This position is required to reside in North Carolina within 40 miles of one of the counties within the Alliance catchment areas (Mecklenburg, Wake, Durham, Orange, Johnston, Harnett, or Cumberland). Responsibilities & Duties Provide Care Team Support Support members transitioning from Inpatient settings to the appropriate lower or lateral level of 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  Collaborate with other Alliance staff, behavioral health providers, primary care...

The Provider Network Evaluator II-Clinical Quality Review (PNE II-CQR) holds and maintains clinical licensure as they are responsible for conducting as well as leading Clinical Quality Reviews (CQR), Oversight Reviews, and Plan of Correction implementation reviews of service providers contracted with Alliance Health. Clinical Quality Reviews are systematic MH/IDD/SUD service line evaluations that take into account member care, service delivery and implementation, adherence to rules and regulation where applicable and established clinical guidelines and principles of best practice. The PNE II-CQR leads, guides, supports, and peer reviews fellow team members work to ensure inter-rater reliability. Additionally, in limited situations, the PNE II-CQR may be assigned to investigate reported concerns to ensure individuals receive clinically sufficient, safe, and effective services rendered by providers in the Alliance Health network.  The PNE II-CQR position is fully remote. The...

The Artificial Intelligence Engineer (AI Engineer) will design, develop, deploy, and integrate machine learning models, AI tools, and other analytics products into Alliance systems and workflows to improve member health, quality of services, and administrative processes. The AI Engineer will help to stand up the foundational platforms and processes that will facilitate development and sustainment of machine learning and artificial intelligence capabilities at Alliance now and into the future. This position is full-time hybrid. Selected candidate must come into the Home office in Morrisville on Wednesdays, for business meeting as needed, reside within 50 miles of Morrisville North Carolina.  Responsibilities & Duties Build and Integrate Machine Learning and Artificial Intelligence Solutions Collaborate with technical managers and cross-functional teams to design, build, and deploy AI/ML models and solutions to improve care management, patient care decisions,...

The CM Data Senior Operations Analyst position will support the design, development, and implementation of care management reporting requirements. This position also conducts quality assurance testing related to reporting, data integrity, and analyses; to include ongoing monitoring and oversight of operational reports. An essential part of the role includes the ability to act as a liaison for Care Management interdepartmentally for interdependencies for data collection and report development efforts. This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC)  for   onsite team meetings as needed. Responsibilities & Duties Reporting Development and Strategy Perform data acquisition, analysis, and evaluation via advanced platform queries, MicroStrategy, Excel, and other data management tools to support departmental reporting  Design solutions to maximize...

The primary purpose of this position is to plan, execute, and finalize projects according to deadlines and within budget as assigned by the Manager of Project Portfolio Management. This involves establishing a team of members who can effectively complete the project based on their skills, knowledge and experience with the subject and meeting with this team on a regular basis to track the progress and ensure the completion of the project.  The Project Manager will be in charge of several projects simultaneously. This is a full-time hybrid opportunity. The successful candidate will be required to report onsite to the Alliance Home office (Morrisville, NC) 2 days per week. Responsibilities & Duties Project Management Form teams of experts required for effective completion of the project, document the projected resources, dates, and goals Frame the the purpose of the whole project and assign team members specific roles and tasks Generate and...

The Information and Communications Specialist III, under general direction, may oversee various departmental activities including creation of internal and external organization communications and marketing/informational materials and campaigns, website content maintenance, video production, and provision of communications technical support to Alliance staff.  Incumbents have significant responsibility for maintenance and enhancement of Alliance's social marketing initiative and contribute to the department’s communications planning. This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office (Morrisville, NC) may be required.   Responsibilities & Duties Manage Complex Organizational Communication Projects Apply advanced experience and expertise to take ownership of complex and organizationally critical projects, and to discern the level of review/input/oversight appropriate from...

The Manager of EDI Development and Support’s primary role is to oversee the development, implementation, and support of our EDI systems, processes and vendor interactions and support. The Manager of EDI Development and Support will collaborate with cross-functional teams, manage EDI projects, and ensure seamless electronic data exchange with our partners and customers. This individual should have a strong technical background in EDI, excellent leadership skills, and a deep understanding of business processes and integration. This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC)  for   onsite team meetings as needed. Responsibilities & Duties Program Management Lead and manage the EDI development and support team, providing guidance, mentorship, and technical expertise Oversee the design, development, and implementation of EDI solutions, ensuring compliance...

The Behavioral Health Clinician is primarily responsible for conducting telephonic screening, triage and referral functions for individuals seeking services.  The Clinician ensures that individuals calling with service needs are safely linked in a timely fashion with available services and/or community resources.  The Clinician may also provide crisis service authorizations for both state and Medicaid funded emergency type services. This position will be equipped with all supplies and technologies to be able to work from home. The selected candidate must reside in North Carolina and is required to attend an initial 6 to 8- week virtual training period, Monday-Friday, between 9a.m. to 5p.m. Transition to permanent schedule to follow a successful training period. Some holiday hours are required. Responsibilities & Duties Conduct Initial Screenings, Assessments, and Reviews, and make referrals Receive escalated calls from specialists who identified callers...

The Implementation Specialist – Innovation and Strategy supports the planning, coordination, and implementation of strategic initiatives within the Innovation and Strategy Division. This position is primarily responsible but not limited to supporting the Rural Health Transformation Project through stakeholder coordination, implementation planning, operational readiness activities, project tracking, and execution support. The Implementation Specialist leads assigned implementation efforts and project workstreams while partnering with project managers, operational leaders, providers, and other stakeholders to ensure project objectives are achieved. This is a grant-funded or time-limited position established for a one-year period with no guarantee of extension, renewal, or continued employment beyond the approved funding period. This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office...

The Senior Director of IDD Strategy & Innovation will lead develop and lead initiatives that strengthen healthcare and community partnerships across Alliance’s catchment area for individuals with intellectual and development disabilities (IDD).   The position will provide strategic leadership for the evolution of Alliance's Intellectual and Developmental Disabilities (IDD) service model, including optimization of the NC Innovations Waiver service continuum, development of innovative care models, and expansion of person-centered services that improve member outcomes and community inclusion. The position works across Alliance departments, the provider network, and community to identify gaps in current services and work to build creative programs to address those gaps.  The position will help design and implement a payment and reimbursement models that promote person-center outcomes and community inclusiveness.  This position does not establish clinical practice standards,...