CFSP Delegated Care Management Monitor (DSS Regions 3/4)

Job description

Job Description

:

#HealthyBlueCareTogetherCFSP

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!

$2,500 SIGN ON BONUS

LOCATION: This position supports DSS Regions 3 and 4.

You must live in one of these regions.

HOURS: General business hours, Monday through Friday.

TRAVEL: Travel within these regions may be required.

When you are not in the field, you will work virtually from your home.

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.

The Delegated Care Management Monitor (Special Programs Case Manager II) is responsible for monitoring and oversight of delegated care management services.

Supports the success of delegated care management services.

Manages overall healthcare costs for the designated population via integrated (physical health/behavioral health) case management and whole person health.

Serves as subject matter expert for the department.

Primary duties may include, but are not limited to:

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 3’s, 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.

Supports member access to appropriate quality and cost-effective care and modifies plan(s) as needed.

Reviews daily reports received by the delegated care management partner(s) to ensure compliance to contractual requirements.

Provides patient education and coordinates with internal and external resources to meet identified needs of the member 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.

Escalates member crises or quality of care concerns appropriately, according to policy.

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.

Coaches the delegated care management entity to improve overall outcomes for the designated population.

For the State of North Carolina, in accordance with federal/state law, scope of practice regulations or contract, the requirements are:

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 LCMHC, LCSW, LMFT, or RN to practice as a health professional within the scope of licensure in the state of North Carolina

Preferred Qualifications:

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.

Experience with oversight and monitoring of delegated care management services is strongly preferred.

Case management certification is preferred.

We are unable to accommodate LCSW-A, LCMHC-A or any other associate level licenses.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed/Certified Behavioral Health Role

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.

Required Skill Profession

Counselors, Social Workers, And Other Community And Social Service Specialists