Alliance Health

Executive Assistant

• Manage the administrative functions for the Member and Provider Services Operations Division
• Set work priorities and assist in running the division day-to-day
• Resolve problems and conflicts using initiative and judgment
• Order and track supplies and monitor P card expenditures
• Liaise with Facilities and vendors on workspace, maintenance, and service issues
• Make travel arrangements for division personnel
• Review and route correspondence; draft, edit, and disseminate letters, memos, and other documents
• Manage calendars and maintain details for the COO and division staff
• Conduct research and interpret and analyze policies, procedures, and processes
• Streamline division office procedures and workflows
• Maintain copier/scanner functionality and coordinate repairs
• Represent the COO on committees or in dealings with external organizations
• Arrange meeting logistics, agendas, documents, technical setup, and invitations
• Prepare and edit presentations; take, transcribe, and publish minutes
• Provide general administrative support, including front desk, phone, visitor, and mail duties
• Work with Human Resources and the COO to attract, maintain, and retain qualified staff
• Ensure staff training, policy compliance, role clarity, resources, and regulatory/accreditation compliance
• Promote a positive, diverse, and inclusive work environment
• Resolve conflicts and disputes and ensure consistent, ethical standards
• Set performance goals, provide feedback, coaching, and mentoring, and support professional development
• Encourage cross-team collaboration and partnership

Executive Assistant I – MPSO

General

• Develop and maintain relationships with network providers
• Provide technical assistance and support to providers
• Recruit providers to fulfill network needs
• Coordinate cross-departmental initiatives identified internally or by the State of North Carolina
• Assist with special initiatives
• Manage and develop staff in collaboration with Human Resources and senior management
• Maintain staff training, policy compliance, workflows, resources, and performance goals
• Provide feedback, coaching, mentoring, and professional development support
• Promote a positive, diverse, inclusive, and respectful working environment
• Resolve conflicts and disputes
• Assign providers to Provider Relations Specialists and maintain recruiting workflows
• Train the team on recruiting tasks and platforms such as Salesforce
• Monitor recruiting goals and team progress
• Analyze the service array and identify provider gaps
• Collaborate with the Director of Provider Network Operations to plan, develop, and implement organizational goals, policies, and procedures

Supv, Provider Relations

Clinician

• Provide coverage for the 24-hour Behavioral Health Crisis line
• Conduct telephonic screening, triage, assessment, and referral functions
• Link individuals safely and promptly with services and community resources
• Provide crisis service authorizations for state- and Medicaid-funded emergency services
• Receive and manage escalated calls involving urgent or emergent needs, including psychosis, suicidality, homicidality, intoxication, withdrawal, or medical emergencies
• Make clinical triage and level-of-care decisions based on limited telephonic information
• Maintain caller safety by contacting and mobilizing EMS, CIT officers, police, mobile crisis teams, and other first responders
• Engage Decision to Warn procedures for callers with active homicidal ideation
• Report to Child Protective Services and Adult Protective Services when warranted
• Identify high-risk and special healthcare-needs populations and refer them to Care Coordination
• Review caller history in the client management system and schedule assessment appointments using the electronic scheduling system
• Complete specialized screening documentation and document incoming call activity in the MCO tracking system
• Operate a multi-function phone system and multiple software programs while managing caller needs
• Conduct follow-up to confirm scheduled assessments and crisis follow-up appointments occur
• Route calls to appropriate MCO departments
• Monitor incoming faxes and overflow vendor reports
• Engage interpreter services when needed
• Provide clinical oversight and review of overflow-vendor calls
• Assist callers with barriers to care and identify available resources
• Provide consultation, support, and training to non-licensed Call Center staff
• Recognize and report quality concerns and atypical call/service-seeking patterns

Behavioral Health Crisis Clinician

Medical Director

• Assist with development of service criteria and standards of care
• Recommend application of medical necessity criteria for service eligibility, including type, amount, and duration
• Help develop processes to assess and document medical necessity
• Assist with development and implementation of the utilization management plan
• Review approval and denial of service requests and care; ensure protocols and audits are completed by appropriately credentialed staff
• Assist with Utilization Management, Quality Management, Care Management, peer reviews, appeals, and reconsiderations
• Review and evaluate treatment procedures and outcomes of psychiatrists and other medical professionals
• Analyze and evaluate patient data and test findings to diagnose mental disorders
• Review consumer information and records, including social and medical history
• Collaborate with physicians, psychologists, pharmacists, social workers, psychiatric nurses, and other professionals on treatment plans and progress
• Provide consultation, training, and education to staff and community partners
• May supervise members of the Medical Management team
• Partner with Human Resources and the Medical Team to attract, maintain, and retain qualified staff
• Ensure staff training, policy compliance, workflow organization, adequate resources, and regulatory compliance
• Promote a positive, diverse, and inclusive working environment
• Resolve conflicts, set performance goals, provide feedback, coaching, and mentoring
• Encourage cross-team collaboration and partnership

Medical Director – Physical Health

Accounts Payable

• Manage and oversee daily Accounts Payable operations, including invoice processing, check runs, aging, write-offs, month-end close, reporting, year-end close, and 1099 processing and filing
• Support internal and external audits and serve as a subject matter expert for Accounts Payable functions and transactions
• Ensure provider and vendor payments and invoices comply with contract terms and posted check-write schedules
• Maintain accurate and timely monthly and annual Accounts Payable module close
• Monitor Accounts Payable aging, investigate outstanding items, and provide detailed reports with explanations and action steps
• Maintain supporting records for payments and expenditures
• Liaise with internal and external customers across the organization
• Maintain understanding of general ledger structure for accurate coding
• Respond to leadership inquiries regarding financial results and special reporting requests
• Maintain ethical business standards and statutory compliance
• Assist with development and maintenance of Claims procedures and processes
• Establish and improve Accounts Payable controls in accordance with best practices and GAAP
• Create and maintain Accounts Payable policies, procedures, and desk manual; train related staff
• Perform internal reviews and identify areas for improvement and training
• Work with Human Resources and the Senior Director of Purchasing and AP to maintain a qualified workforce
• Organize workflows and ensure staff understand roles and responsibilities
• Provide tools and resources supporting organizational goals, compliance, and employees
• Promote a positive, diverse, and inclusive work environment
• Resolve conflicts and disputes and ensure fair, ethical standards
• Set performance goals and deadlines aligned with organizational goals
• Provide feedback, coaching, mentoring, and professional development support
• Encourage cross-team collaboration and partnership
• Provide continuous training and education to Alliance staff
• Provide daily support and consultation to staff, external vendors, and providers regarding Accounts Payable processes
• Assist with strategic and innovative operations that increase efficiency and effectiveness

Manager, Accounts Payable

Director

• Administer and coordinate physical health utilization management activities for Alliance
• Ensure the UM Department operates as an integrated department providing holistic member-needs reviews
• Oversee staff, workflows, goals, performance, training, coaching, mentoring, and professional development
• Maintain compliance with organizational policies, licensure, regulatory, accreditation, and contract requirements
• Oversee delegated utilization management vendors and monitor compliance with delegation agreements and corrective action plans
• Oversee reviews of physical health services and ensure consistent application of medical necessity criteria
• Develop and implement department policies, procedures, authorization systems, and corrective plans
• Protect client rights and ensure timely treatment-request processing and due process
• Educate hospitals, nursing homes, and other care providers on departmental procedures and requirements
• Analyze community service capacity, service gaps, utilization patterns, and evidence-based practices
• Advise on Medicaid and Non-Medicaid benefit plans and Utilization Management Committee trends and performance measures
• Collaborate with department heads, decision makers, Medical Directors, specialists, and primary care physicians
• Perform other related duties as assigned by Alliance Health administration

Director, Utilization Management – Physical Health

• Support Alliance Health’s efforts to identify, reduce, and eliminate health disparities
• Schedule and perform community outreach, engagement, and health education initiatives
• Conduct community-based research on health equity, population health, social determinants of health, housing, healthcare access, transportation, economic, and communication issues
• Support member outreach strategies for preventive care, chronic disease management, maternal and child health, behavioral health access, and priority quality measures
• Monitor health equity standards, Medicaid managed care requirements, accreditation expectations, and disparity-reduction practices
• Support strategic planning activities advancing racial and health equity
• Assist with state and regulatory deliverables, required processes, tracking, policies, manuals, and procedures
• Attend staff, state, workgroup, and community meetings representing Alliance Health
• Assess community needs and coordinate Health Equity Department projects and initiatives
• Analyze social drivers of health data, identify disparities, and recommend targeted interventions
• Assist with training and technical assistance on health equity, cultural humility, bias awareness, language access, disability inclusion, and equitable care delivery
• Support accreditation, regulatory, contract, and reporting requirements
• Inform Alliance policy development regarding health and other disparities and inequities
• Prepare and deliver public presentations, facilitate conversations, and provide health equity education
• Develop quality management models, member communication strategies, outreach efforts, reporting, program evaluation, and related projects
• Monitor data trends, develop action plans, and recommend corrective actions
• Support HEDIS performance initiatives by identifying care gaps, monitoring disparities, and coordinating interventions
• Develop and maintain reports, webpage content, presentations, and briefing materials
• Coordinate Health Equity Workgroup events, programs, and projects
• Advocate for marginalized communities internally and externally
• Generate and facilitate health equity training, workshops, and outreach efforts
• Partner with cross-functional teams to integrate health equity goals into workflows and performance improvement projects
• Participate in assigned workgroups and committees
• Travel between Alliance offices and to meetings, events, members, providers, and stakeholders
• Perform other related duties as assigned

Health Equity Specialist

Analyst

• Supervise, coach, and develop a team of licensed clinicians and unlicensed staff performing provider-led Tailored Care Management record reviews
• Establish performance expectations and monitor productivity, quality, and timeliness metrics
• Conduct regular staff meetings, performance evaluations, and individual coaching sessions
• Provide guidance regarding monitoring processes, documentation standards, and departmental procedures
• Foster a culture of accountability, collaboration, continuous improvement, and operational excellence
• Oversee the planning, execution, and completion of provider-led Tailored Care Management record reviews
• Monitor workflows and staffing assignments to ensure timely completion of deliverables
• Review monitoring findings for consistency, accuracy, and adherence to established audit methodologies
• Ensure monitoring tools, scoring criteria, and reporting processes are applied consistently across the team
• Identify trends, gaps, and opportunities for process improvement based on monitoring results
• Ensure monitoring activities comply with applicable federal and state regulations, accreditation standards, organizational policies, and contractual requirements
• Collaborate with Sr. Director of Network Evaluation and Compliance Committee to address identified issues and corrective actions
• Support preparation for internal and external audits, reviews, and accreditation activities
• Monitor changes in requirements and communicate necessary updates to staff and stakeholders
• Collaborate with other Tailored Plans, NC DHHS, Practice Transformation, and Sr. Director of Network Evaluation regarding monitoring activities and provider quality improvement
• Serve as a subject matter expert on provider-led Tailored Care Management monitoring requirements and standards
• Support provider education and technical assistance related to compliance and quality expectations
• Participate in regulatory reviews, audits, and accreditation activities
• Analyze monitoring data and performance metrics to identify patterns and improvement opportunities
• Prepare and present routine and ad hoc reports for leadership
• Track monitoring outcomes, corrective actions, and performance indicators
• Support organizational quality improvement initiatives through data-driven recommendations
• Does not provide direct patient care, make clinical treatment decisions, or serve as a clinical supervisor for licensed staff

Supervisor, External Clinical Quality Analyst

Data Engineer

• Define, own, and execute the enterprise data platform strategy and roadmap
• Lead the transition from legacy EDW architecture to a cloud-native Lakehouse and data engineering platform
• Establish platform success metrics for scalability, reliability, performance, cost management, and business value
• Serve as executive-level authority for enterprise data platform direction and technical decisions
• Lead and develop the Data Platform Engineering team
• Establish role clarity, career pathways, and performance expectations
• Coach and mentor senior technical staff
• Build a sustainable internal delivery model reducing reliance on consultants
• Establish and enforce enterprise standards for data ingestion, transformation, serving layers, medallion and Lakehouse architecture, CI/CD, DevOps, environment management, monitoring, observability, and production support
• Oversee and approve complex architecture and solution designs
• Ensure consistent engineering practices across data domains and delivery teams
• Implement enterprise-wide data quality standards, validation frameworks, and monitoring
• Partner with Security, Compliance, and Governance teams on HIPAA/HITECH, data classification, encryption, access controls, and audit logging
• Maintain accountability for platform stability, incident response, and root-cause remediation
• Provide executive oversight for data domain migrations, analytics and reporting modernization, and legacy EDW decommissioning
• Manage cross-functional dependencies, delivery risks, and modernization sequencing
• Report delivery status, risks, and outcomes to executive leadership
• Liaise between IT leadership, business stakeholders, analytics teams, and external partners
• Translate business and regulatory requirements into scalable technical capabilities
• Communicate platform strategy, risks, progress, and outcomes to executive leadership

Director, Data Platform Engineering

Customer Support

• Oversee timely and effective transitions of care between Alliance Health Plan and other health plans or Provider Led Entities
• Provide episodic transition support, including warm handoffs, state-required assessments, reporting, and follow-up care coordination
• Manage transition-related data and respond to inquiries regarding transition dates, Tailored Care Management status, and episode accuracy
• Ensure accurate referrals to appropriate clinical services
• Communicate and collaborate with internal care management teams, leadership, Provider Led Entities, Alliance departments, and external stakeholders to resolve transition barriers
• Maintain effective team workflow and reporting requirements to Alliance leadership and the state
• Supervise, coach, mentor, and develop staff
• Coordinate internal and external partners to ensure timely, informed, and seamless care transitions
• Manage inbound and outbound communications related to transition planning, data accuracy, and care coordination
• Oversee and triage requests received through the TST email box
• Pull, analyze, validate, interpret, and synthesize transition data into integrated reports
• Identify and resolve transition-related issues to minimize care gaps and enhance member outcomes
• Ensure professional documentation in the electronic medical record and email communications
• Provide administrative oversight, escalate issues, and supervise complex cases
• Participate in management and clinical team meetings
• Develop or assist with policies, procedures, and workflows for the Tailored Plan and member transitions
• Recommend improvements to department procedures and operational efficiency
• Monitor trends and identify opportunities to enhance member transitions, service utilization, and implementation
• Ensure adherence to organizational, departmental, state, and federal policies and regulations
• Travel between Alliance offices and attend meetings, events, member/provider/stakeholder meetings, and court hearings as required

Supervisor II – Transition Support Specialist

• Design and implement scalable enterprise-wide data architecture
• Optimize data performance and accessibility while ensuring data quality, integrity, and security
• Lead adoption of modern data architecture patterns and cloud-native solutions
• Define future-state data architecture roadmaps aligned with organizational strategy and modernization initiatives
• Develop enterprise data management strategies, including data lake/warehouse implementations, data movement, and data services
• Establish data access patterns, serving layers, semantic models, and APIs for downstream analytics and reporting
• Participate in business analysis activities to elicit data product requirements
• Define reference architectures, coding standards, and reusable patterns for data engineering teams
• Review and approve solution designs for adherence to enterprise data architecture standards
• Provide technical mentorship and design guidance to engineers and analysts
• Participate in the data governance council and contribute to data standards and policies
• Collaborate with security and compliance teams on data classification, encryption, access controls, and audit logging
• Ensure data architectures comply with HIPAA and organizational data privacy standards
• Capture end-user requirements and align technical solutions with strategic business objectives
• Translate business needs into scalable, secure, and well-governed data architecture solutions
• Provide architectural expertise and leadership guidance to data engineering teams

Cloud Data Architect

Solutions Engineer

• Design and maintain enterprise CRM solutions, including Salesforce solution architecture, data models, integration patterns, declarative automation, and security structures
• Ensure solution designs align with enterprise architecture principles, compliance requirements, and performance best practices
• Evaluate new Salesforce features, AppExchange solutions, and emerging technologies
• Support the Salesforce Center of Excellence and uphold governance standards, design patterns, documentation practices, naming conventions, and release processes
• Participate in backlog prioritization, SDLC reviews, and architectural quality assurance
• Create and maintain architecture documentation, including diagrams, integration patterns, data models, specifications, requirements, and reusable templates
• Partner with IT, Operations, business leadership, and external vendors to translate business needs into scalable CRM solutions
• Identify solution risks, provide mitigation strategies, and support investment planning
• Design and govern integrations for Salesforce, telephony platforms, data systems, and enterprise applications
• Collaborate with engineers, developers, and data teams to ensure integration reliability, consistency, and maintainability
• Oversee API usage, error handling practices, and data flow diagrams
• Conduct performance assessments of flows, Apex, integrations, and data structures
• Recommend and implement optimization strategies for stability, data quality, and system performance
• Support modernization initiatives involving cloud adoption, automation, artificial intelligence, and digital engagement
• Serve as a technical resource and escalation point for complex solution designs, integration issues, performance concerns, and cross-system architectural challenges
• Conduct design reviews and provide guidance on architectural frameworks, secure design, data modeling, and CRM best practices
• Share specialized knowledge with team members without supervising or directing their work
• Collaborate with IT, Business Operations, Clinical Operations, Member & Provider Services, data teams, and external vendors

CRM Solution Architect – Full-time

Manager

• Assure integrated whole-person care management for individuals and families with special health care needs
• Coordinate physical health, behavioral health, pharmacy, and unmet health-related resource needs
• Complete comprehensive assessments and Care Needs Screenings
• Develop and update Plans of Care
• Assign interventions and care activities to appropriate care management team members and Community Health Workers
• Submit referrals for medically or pharmaceutically complex needs
• Assist members or legally responsible persons in choosing service providers
• Evaluate service appropriateness and monitor implementation of Plans of Care
• Use person-centered planning, motivational interviewing, and JIVA assessment history
• Collaborate with members, guardians, care teams, service providers, community systems, and stakeholders
• Schedule and conduct face-to-face, virtual, and telephone meetings
• Educate members about Alliance Health Plan, rights, grievances and appeals, services, providers, and payer requirements
• Recognize and report critical incidents and provider quality concerns
• Coordinate transitions to appropriate levels of care and community-based services
• Identify treatment barriers and assist with appointments and treatment-provider linkages
• Maintain required member contacts and attend community, provider, and stakeholder meetings
• Obtain, upload, and maintain supporting documentation and releases of information
• Open episodes and maintain member records in JIVA, Clive, and TCLD
• Escalate complex cases and ensure clinical documentation meets state, agency, and Medicaid requirements
• Complete TCL monitoring requirements supporting tenancy, health, safety, community integration, housing, and provider coordination
• Support supportive-housing tenancy stability, voucher applications, rehousing, bridge/hotel-program transitions, and housing separations
• Educate members about IPS-SE employment, community integration, and education referrals
• Travel between Alliance offices and to meetings, member/provider/stakeholder appointments, court hearings, and Alliance-sponsored events

Care Manager I – TCL

• Lead all communication among care team members and serve as the primary point of contact for the member
• Complete comprehensive assessments at enrollment, annually, or upon changes in condition
• Develop Plans of Care for Tailored Plan recipients
• Assign interventions and Plan of Care activities to Care Workers and Community Health Workers
• Submit referrals to Integrated Health Consultants for complex physical, behavioral health, or pharmaceutical needs
• Assist individuals and legally responsible persons in choosing service providers objectively
• Evaluate service appropriateness and ensure Plan of Care implementation
• Use person-centered planning, motivational interviewing, and historical Jiva assessment reviews to identify needed supports
• Collaborate with care teams, members, and service providers to develop individualized plans
• Submit required documentation to Utilization Management and troubleshoot authorization issues
• Schedule and conduct member contacts, face-to-face meetings, education, and support
• Explain rights, grievance and appeals processes, service options, providers, and payer requirements
• Recognize and report critical incidents and provider quality concerns
• Coordinate transitions to appropriate levels of care and attend treatment meetings
• Schedule, coordinate, and lead team conference calls
• Monitor member status, care needs, service adherence, and emerging clinical needs
• Obtain, upload, and share supporting documentation, releases, consents, and legal/guardianship verification
• Open episodes in JIVA and document member updates and activities
• Escalate complex cases to the Supervisor and distribute member surveys
• Obtain service orders and clinical documentation as applicable
• Coordinate transitions when individuals move outside the Alliance MCO geographic area
• Ensure documentation meets state, agency, and Medicaid requirements
• Travel between Alliance offices and to members, providers, stakeholders, and court hearings as required

Care Manager II

• Support network providers in evolving administrative and clinical workflows and processes to improve outcome-based care
• Assist care management providers with site billing setup, claims processing, data-informed care management, interventions, workflows, policies, and procedures
• Educate practices and clinically integrated networks (CINs) on continuous quality improvement principles, interventions, PDSA cycles, and data-driven care
• Review performance reports, panel and engagement rates, quality dashboards, gaps in care, medical economics dashboards, emergency department visits, utilization, and other performance data with providers and CINs
• Present data in an understandable format to drive improved member care
• Collaborate with AMHs and CMAs to integrate administrative, financial, and clinical systems and data
• Conduct gaps analysis and use the Gaps Analysis and CQI Rubric to strengthen care management entity performance
• Facilitate agency adoption of 1915(i) processes and impacts of HR.1 and other state programs
• Deliver practice-level education, training, and toolkits covering HEDIS measures, Alliance initiatives, and state requirements
• Educate providers on JIVA, NCCARES 360, Inovalon, Siftwell’s Pegasus, Medical Economics dashboards, and MicroStrategy reports
• Provide customized coaching at clinical sites to identify needs, prioritize focus areas, and use data for care management and alternative payment models
• Create and deliver presentations on data-informed care management, value-based contracting, CQI, and alternative payment models
• Produce reports on quality, financial, and utilization goals and share quality and clinical outcomes
• Support implementation of provider-led care management and ensure fidelity to the care model
• Create sustainability tools, address implementation barriers, propose solutions, and guide clinical staff and leadership on best practices
• Assist providers with panel management and understanding panel assignments
• Create project plans, toolkits, training materials, user education, and evaluation materials with interdisciplinary teams
• Collaborate with Quality Management, Provider Network Evaluation, Care Management, Finance, IT, and Care Management Liaison departments
• Communicate file and data-source changes to providers and resolve member-facing barriers, issues, and concerns