Alliance Health

The Supervisor of Contracts and Enrollment provides day-to-day oversight of all provider enrollment and contracting functions. The Supervisor of Contracts and Enrollment works with the Manager of Provider Contracts and Enrollment to implement all unit and departmental goals, and ensure internal and external requirements for provider contracting are met. 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 Supervise Day-to-Day Unit Operations Supervise day-to-day operations of the Enrollment and Contracting teams to ensure timely and accurate completion of all enrollment and contract requirements Ensure all enrollment and contract processes are consistent across new and existing providers Monitor...

The Data Analyst-Organizational Culture & Engagement is responsible for collecting, analyzing, and interpreting workforce data to support initiatives that strengthen organizational culture, enhance employee engagement, improve employee experience, and equip managers with actionable insights. This role partners with Human Resources, people leaders, and key stakeholders to measure the effectiveness of culture and engagement strategies, identify trends, and develop data-driven recommendations that align with organizational values and business objectives. The analyst creates dashboards, reports, and assessments that provide meaningful insights into employee sentiment, workplace experiences, and organizational health. By leveraging qualitative and quantitative data, this role helps drive continuous improvement efforts, supports informed decision-making, and advances a positive, inclusive, and high-performing work environment. This position will allow the successful candidate...

The Administrative Clinical Support Specialist I performs a range of administrative tasks, resolves problems and may coordinate administrative support activities that require knowledge of program operations, policies, and processes.  The position will be responsible for the transferring of clinical data, conducting pre-review screening of prior authorization requests, completing discharge documentation, and ensuring administrative supports are in place to meet required departmental deadlines in accordance with contractual, federal and accreditation standards. This position is fulltime remote. Selected candidate must reside in North Carolina. While there is no expectation of being in the office routinely, they may be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as needed. Responsibilities & Duties Program Operations Triage, process, and gather clinical information to build prior authorization requests...

This position performs professional and administrative work, primarily utilization review and utilization management to ensure economical and effective consumer service delivery by the PHIP enrolled network providers. The position is responsible for providing 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 their individual needs. The position’s primary role is to review services for members identified as meeting ICF Level of Care and participating in the Innovations Waiver 1915 (c), Traumatic Brain Injury Waiver. This position is fulltime remote. While there is no expectation of being in the office routinely, the selected candidate may be required to report to their Alliance local office location for business meetings as needed. Responsibilities & Duties Utilization Reviews and Management Conduct independent medical...

Description   Department Description As a specialized function of Human Resources, the Talent Acquisition (TA) Team strategically identifies, attracts, and hires highly qualified professionals to meet long-term organizational staffing goals.   Role Description   Alliance is seeking a Fall 2026 or Spring 2027 intern to join the Human Resources Talent Acquisition team. The ideal candidate is motivated to learn and develop skills in recruitment and HR processes. This role supports core HR functions, including recruiting coordination, document management, and career fair logistics. The intern will work remotely and must reside in North Carolina. Compliance training in Morrisville is required prior to the start date.   While there is no expectation of coming into the office routinely, the selected candidate must reside in NC and be available to report onsite to the Alliance Home Office (Morrisville, North Carolina) for business meetings as...

The NCQA Quality & Accreditation Specialist serves as the project management lead and subject matter expert for assigned NCQA standard areas and manages the assessment of related business functions for corresponding departments within the scope of NCQA standards (e.g. Provider and Member Services, Utilization Management, Population Health, Care Management, Provider Network, Member and Provider Communications, Delegation Oversight) to support high-quality performance and ensure successful NCQA Accreditation process. This position is fulltime remote. While there is no expectation of being in the office routinely, they may be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as needed. Responsibilities & Duties Implement and Monitor Accreditation Workplan Project management lead for assigned NCQA standard categories within the organization’s QI workplan to achieve and maintain Health Plan Accreditation...

The Grievance and Appeals Analyst responds to grievances and appeals to ensure the resolutions are consistent with organizational policies and procedures and which are compliant with state and federal guidelines and also ensures due process rights. The Analyst synthesizes and analyzes all available data which may contain multiple issues and may require coordination of responses from multiple business units.  The Analyst ensures timely, customer focused responses to complaints and appeals, identifies trends and emerging issues, reports and recommends solutions. Works with internal and external customers to gather and verify information related to consumer safety and provider compliance. Identifies critical issues and triages issues appropriately to ensure that urgent member needs are met expediently. Communicates trends and actionable analysis to appropriate parties in a timely manner. This position is full-time remote. Selected candidate must reside in North Carolina and be...

The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services,  monitors consumer treatment through ongoing and continuous review to ensure that services are delivered based on consumer need and established clinical guidelines, and identifies and follows-up on clinical cases of concern and high-risk/special needs consumers to ensure enrollees are linked to appropriate treatment resources.  The UM Clinical Specialist RN - PH may represent the unit in cross agency collaborative needs.  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. Responsibilities & Duties Assesses the medical necessity of services Independently conduct medical necessity reviews of service...

The Care Manager l-Non-Waiver 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 – Non-Wavier 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. This is a full-time hybrid opportunity. While there is no expectation of coming into the office routinely, the selected candidate must be available to report onsite to the Alliance Office...

The Care Management Consultant is a highly trained and experienced Clinician working in a consultive role and providing secondary Case Management as part of Alliance’s Multidisciplinary Care Management Team for members with Physical Health needs.   The Care Management Consultant offers on-demand recommendations, provides Physical Health related education within their scope of licensure, completes Medication Reviews, and escalates review of complex cases to Medical Directors and/or Pharmacists as necessary, to optimize health outcomes for the member. This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices  for   onsite team meetings as needed. Responsibilities & Duties Provide Care Team Support Support members transitioning from institutional care settings to community-based care  Provide subject matter expertise, within scope, regarding member’s physical and/or behavioral...

This position plans, designs, implements, conducts, and reports program evaluations of services delivered to recipients, including process/implementation evaluation, outcome evaluation, and cost benefit analysis.  Ensures that services delivered are consistent with funding requirements, best practices, provider contracts and federal/state rules and regulations.  Utilizes both qualitative and quantitative evaluation methods.  Interprets data, analyzes results using statistical techniques and assures that results are disseminated in written and oral formats in a manner that promotes continuous quality improvement.  Reviews and synthesizes existing research and evaluation information on priority topics for Alliance to ensure programs and service decisions are informed and guided by research, including appropriate expectations about return on investment for programs, and identification of promising alternatives for underperforming services. This position is a provisional...

The Administrative Assistant III provides administrative support to the claims team to ensure the efficient operation of the team, including handling high volume incoming and outgoing mail and high-volume inbound calls. The Administrative Assistant III also completes specific claims-related responsibilities including performing a range of clerical tasks, maintaining databases and spreadsheets, conducting research, preparing reports, handling inquiries, receiving/screening/keying paper claims, and other activities that require knowledge of program operations, policies, and processes. Responsibilities & Duties Provide Administrative Support to Manager and Team Maintain files, reports and other data, including aggregating data from multiple sources and uploading documents to various systems within Alliance Manage organizational and departmental records and report on activities involving implementation of program objectives using existing procedures or devising new...

The Care Manager l-Non-Waiver 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 – Non-Wavier 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. This is a full-time hybrid opportunity. While there is no expectation of coming into the office routinely, the selected candidate must be available to report onsite to the Alliance Office...

The TCL Transition Coordinator is responsible for assisting individuals who have agreed to community living exiting an institutional care setting. This position will support a person in securing and managing appropriate services, housing and community resources and requires a high level of collaboration and problem solving with internal and external stakeholders . This is a full-time hybrid opportunity. There is no expectation of coming into the office routinely, however, the selected candidate must be available to report onsite to the Alliance Office (Morrisville, North Carolina) for business meetings as needed. The successful candidate will also be required to travel throughout Wake County and surrounding counties (including ones outside of Alliance’s catchment area) to meet with members, providers and/or other community stakeholders. Responsibilities & Duties Conduct Assessments and Planning Assist the treatment team with members...

The Grievance and Appeals Analyst responds to grievances and appeals to ensure the resolutions are consistent with organizational policies and procedures and which are compliant with state and federal guidelines and also ensures due process rights. The Analyst synthesizes and analyzes all available data which may contain multiple issues and may require coordination of responses from multiple business units.  The Analyst ensures timely, customer focused responses to complaints and appeals, identifies trends and emerging issues, reports and recommends solutions. Works with internal and external customers to gather and verify information related to consumer safety and provider compliance. Identifies critical issues and triages issues appropriately to ensure that urgent member needs are met expediently. Communicates trends and actionable analysis to appropriate parties in a timely manner. This position is full-time remote. Selected candidate must reside in North Carolina and be...

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 hybrid opportunity. 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. The successful candidate will also be required to travel weekly throughout Cumberland County 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 Assign interventions/plans of care to the...

The Health Promotion and Outreach specialist conducts targeted member outreach related to health promotion, wellness, chronic condition management, maternal and child health, substance use, tobacco prevention and other population health initiatives using telephone, member portal, text, email, mail, and related modalities. The Health Promotion and Outreach Specialist provides education on benefits available through Alliance and its network to address unmet member healthcare needs. The Health Promotion and Outreach Specialist refers to Care Coordination, Care Management and primary care as needed.  This position is also responsible for advancing a System of Care approach by collaborating on development of member-focused education and training needs, curricula and educational initiatives. Through the implementation of system level solutions, this position enhances cross-functional collaboration, promotes access to essential services and analyzes emerging trends to support...

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 will allow the successful candidate to work primarily remote. While there is no expectation to be in the office routinely, the selected candidate may be required to report on-site as needed. It's strongly preferred that the selected candidate reside in North Carolina or be willing to relocate. This position may be required to work weekends and holidays based on organizational and operational requirements. Responsibilities & Duties Clinical Oversight & Medical Review Provide expert guidance and oversight for physical health service requests, including...