Position Type: In office with potential to shift to Remote
Employment Type: Full-Time
Locations: Raleigh, Durham and surrounding areas
Compensation: Position Type: Remote (Eastern North Carolina)
Employment Type: Full-Time
Compensation: Salaried, travel factored into salary
Department: Tailored Care Management
Reports To: TCM Supervisor
Position Summary
Sigma Health Services is seeking a dedicated and compassionate Tailored Care Management (TCM) Care Manager to support Alliance Medicaid members by coordinating whole-person care that addresses behavioral health, medical health, and social determinants of health needs. The TCM Care Manager will serve as the primary point of contact for assigned members, assisting them in navigating healthcare systems, accessing community resources, and achieving individualized goals through person-centered care planning.
This position requires a strong understanding of care coordination, behavioral health systems, medical health needs, and the North Carolina Tailored Care Management model. The ideal candidate will have experience working with individuals receiving behavioral health and physical health services and demonstrate the ability to collaborate effectively with providers, community agencies, and multidisciplinary care teams.
Although this is a remote position, the Care Manager must be located in The Triangle to complete required in-person member contacts. This role requires consistent productivity, including maintaining daily billable service activities, timely documentation, and active engagement with assigned members.
Essential Responsibilities, Member Support & Care Coordination
- Manage an assigned caseload of Medicaid members enrolled in Tailored Care Management services.
- Build strong, trusting relationships with members while providing person-centered support and advocacy.
- Complete comprehensive assessments, including understanding member needs related to physical health, behavioral health, substance use, housing, transportation, employment, and other social determinants of health.
- Develop, implement, and monitor individualized care plans in collaboration with members, families, providers, and support systems.
- Assist members in accessing appropriate medical, behavioral health, and community-based services.
- Support members in achieving identified goals through ongoing outreach, coordination, and follow-up.
1915(i) Process & Service Coordination
- Demonstrate knowledge and understanding of the North Carolina Medicaid 1915(i) service process, including eligibility requirements, assessments, documentation expectations, and coordination of approved supports.
- Assist members with navigating the 1915(i) assessment and authorization process as applicable.
- Coordinate with providers and community supports to ensure services align with member needs and approved care plans.
- Maintain accurate documentation related to 1915(i) assessments, referrals, service coordination, and member progress.
Provider Collaboration & Team-Based Care
- Maintain consistent communication and collaboration with behavioral health providers, medical providers, hospitals, community organizations, and other involved supports.
- Participate in care team meetings and coordinate services across multiple systems to ensure continuity of care.
- Establish professional relationships with providers to support effective communication, timely referrals, and improved member outcomes.
- Advocate for members while promoting collaboration among all members of the care team.
Documentation & Compliance
- Complete timely, accurate, and thorough documentation of all member interactions, interventions, referrals, and care coordination activities.
- Maintain documentation standards that support Medicaid billing requirements, audits, and quality improvement initiatives.
- Enter required information into electronic health record systems, tracking systems, and applicable state-required platforms.
- Ensure documentation clearly reflects the service provided, member needs, interventions completed, and outcomes achieved.
Productivity & Service Expectations
- Maintain daily billable service activities (i.e. member contacts, and documentation) in accordance with agency productivity expectations and Medicaid requirements.
- Complete required member contacts, including telephonic, virtual, and in-person interactions.
- Proactively engage members through outreach, follow-up, and resource coordination.
- Manage time effectively to meet productivity expectations while maintaining quality of service delivery.
- Maintain accurate calendars, service tracking, and required reporting.
Required Qualifications
- Bachelor’s degree or higher in Social Work, Psychology, Counseling, Human Services, Healthcare Administration, Nursing, Public Health, or a related field (degree required).
- Experience working in a medical, behavioral health, care coordination, case management, or human services setting strongly preferred.
- Experience with 1915(i) assessments, service planning, or authorization processes.
- Knowledge and understanding of behavioral health and/or physical health systems.
- Strong written and verbal communication skills.
- Excellent organizational skills and ability to manage multiple priorities independently.
- Strong documentation and clinical writing skills.
- Ability to work remotely while maintaining accountability, productivity, and professional communication.
- Reliable transportation required
Preferred Qualifications
- Experience with North Carolina Medicaid Tailored Care Management (TCM).
- Knowledge of NC Medicaid systems, LME/MCO processes, and community-based services.
- Experience collaborating with behavioral health providers, primary care providers, hospitals, and community agencies.
- Familiarity with electronic health records and documentation platforms.Skills & Competencies
- Person-centered and recovery-oriented approach.
- Strong advocacy skills.
- Experience working with Medicaid populations preferred.
- Ability to build rapport with diverse populations.
- Ability to work independently while remaining connected with a remote team.
- Commitment to quality documentation and compliance standards.
- Strong problem-solving and resource coordination skills.
Work Requirements
- Remote position serving members throughout Raliegh and Durham
- Must maintain reliable internet access and a professional remote workspace.
- Must be available for required in-person member contacts and community-based meetings.
- Must consistently meet productivity, documentation, and billing expectations.
- Must maintain confidentiality and comply with HIPAA and Medicaid regulations.
Why Join Sigma Health Services?
At Sigma Health Services, our Care Managers play a vital role in improving outcomes for individuals with complex medical, behavioral health, and social needs. We are committed to providing meaningful support, collaborative care, and services that empower members to achieve stability and improved quality of life.
Job Types: Full-time, Contract
Pay: $48,000.00 - $52,000.00 per year
Benefits:
Education:
Experience:
- ICD-10: 1 year (Preferred)
- Behavioral or physical health: 1 year (Required)
Language:
Ability to Commute:
- Raleigh, NC 27629 (Required)
Work Location: In person
