Managed Care Coordinator
Managed Care Coordinator
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Job Description
Anticipated End Date:
Position Title:
Managed Care CoordinatorJob Description:
Managed Care Coordinator
We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaidenrolled infants children youth young adults and families served by the child welfare system so that they receive seamless integrated and coordinated health care. Within the Children and Families Specialty Plan (CFSP) and regardless of where a member lives they will have access to the same basic benefits and services including Physical health Behavioral health Pharmacy Intellectual/Developmental Disabilities (I/DD) services long term services and supports Unmet healthrelated resource needs and Integrated care management. We envision a North Carolina where all children and families thrive in safe stable and nurturing homes.
The Managed Care Coordinator is responsible for the overall management of members individual service plan within the scope of position in the NC CFSP Program as required by applicable state law and contract.
How you will make an impact:
- Responsible for performing telephonic or facetoface history and program needs assessments using a tool with predefined questions for the identification evaluation coordination and management of members program needs.
- Using tools and predefined identification process identifies members with potential clinical health care needs (including but not limited to potential for high risk complications) and coordinates those members cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.
- The process does not involve clinical judgment.
- Manages nonclinical needs of members with chronic illnesses comorbidities and/or disabilities to insure cost effective and efficient utilization of services.
- Establishes short and long term goals in collaboration with the member caregivers family natural supports and physicians.
- Identifies members that would benefit from expanded services.
Minimum Requirements
- Requires BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience which would provide an equivalent background.
Preferred Skills Capabilities and Experiences:
- BA/BS degree field of study in health care related field preferred.
- Specific education and years and type of experience may be required based upon state law and contract requirements.
- Travels to worksite and other locations as necessary.
- For MMP requires Community Health Worker certification to be obtained within one year of employment.
Job Level:
NonManagement NonExemptWorkshift:
Job Family:
MED > Care Coord & Care Mgmt (NonLicensed)Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success for our consumers our associates our communities and our business.
We offer a range of marketcompetitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Required Experience:
IC
Employment Type
Full Time
