Delegated Care Management Monitors (Special Programs Case Mgr II)

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Job Description:

Special Program Case Manager II

We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaid-enrolled 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 health-related resource needs and Integrated care management. We envision a North Carolina where all children and families thrive in safe stable and nurturing homes.

North Carolina residency is required!

$2000 SIGN ON BONUS

Locations: The selected candidate must reside within a reasonable commuting distance of the designated region(s): Region 1: Buncombe Cherokee Clay Graham Haywood Henderson Jackson Macon Madison Mitchell Polk Swain Transylvania Yancey. Region 2: Alexander Alleghany Ashe Avery Burke Caldwell Catawba Cleveland Gaston Lincoln McDowell Mitchell Watauga Wilkes. Region 3: Alamance Caswell Chatham Davidson Davie Durham Edgecombe Franklin Granville Guilford Harnett Lee Person Rockingham Rowan Stokes Surry Vance Wake Warren Wilson.

Field:This field-based role enables associates to primarily operate in the field traveling to client sites or designated locations as their role requires with occasional office attendance for meetings or training. This approach ensures flexibility responsiveness to client needs and direct hands-on engagement.

Please note that per our policy on hybrid/virtual work candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.

Travel within your assigned county is required. When you are not in the field you will work virtually from your home.

The Special Program Case Manager II is responsible for performing case management telephonically and/or by home visits within the scope of licensure for special programs such as Foster Care. Manages overall healthcare costs for the designated population via integrated (physical health/behavioral health) case management and whole person health. Manages a significantly larger and more complex caseload as compared to Special Programs Case Mgr I. Serves as subject matter expert for the department.

How you will make an impact:

• Conducts assessments to identify individual needs.
• Reviewing care plans and ensuring compliance with the service delivery of the delegated care management partner(s) who are in contract with Healthy Blue. Partners may include AMH Tier 3s Certified Care Management Agencies and Clinically Integrated Networks.
• Healthy Blue Care Together (Children and Families Specialty Plan) and its care management partners assign a dedicated care manager to each client responsible for: comprehensive care management care coordination health promotion transition care individual and family support and referral to community services.
• Develops comprehensive care plan to address objectives and goals as identified during assessment.
• Supports member access to appropriate quality and cost-effective care and modifies plan(s) as needed.
• Coordinates with internal and external resources to meet identified needs of the member in terms of integrated (physical and behavioral) whole person care.
• Coordinates social determinants of health to meet the needs of the member and incorporates that into care planning.
• Works closely with various state agencies.
• Maintains knowledge of the system of care philosophy; a spectrum of effective community-based services and supports for those with or at risk for mental health or other challenges and their families that is organized into a coordinated network.
• Builds meaningful partnerships with designated populations and their families and addresses cultural and linguistic needs in order to help them function better at home in the community and throughout life.
• Evaluates health needs and identifies applicable services and resources in conjunction with members and their families.
• Provides important information including patient education medication reconciliation and identification of community resources and assists with arrangement of follow-up care.
• Works on strategic projects related to specialty populations.
• Assists with onboarding new associates.

Minimum Qualifications:

• Requires MS/MA in social work counseling or a related behavioral health field or a degree in nursing and minimum of 5 years of clinical experience in social work counseling with broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background.
• Requires an active current and valid license as an RN LCSW (as applicable by state law and scope of practice) LMHC LPC (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.
• Certified Case Manager Certification is also required

Preferred Skills Capabilities and Experiences:

• Knowledge of resources supports services and opportunities required for safe community living for populations receiving in-reach and transition services including LTSS Behavioral Healththerapeutic and physical health services.
• Experience working with Children Youth and Families who are being served by Local Departments of Social Services through Foster Care and Adoptive Assistance programs is very strongly preferred.
• Service delivery coordination discharge planning or behavioral health experience in a managed care setting preferred.
• Travels to worksite and other locations as necessary.

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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 market-competitive 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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 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.