CFSP Managed Care Coordinator - Gaston County

Elevance Health•Gastonia, NC

4d•Onsite

About The Position

The CFSP Managed Care Coordinator manages members’ individual service plans within the scope of the North Carolina Children and Families Specialty Plan (CFSP), as required by applicable state law and contract. The CFSP is a statewide Medicaid plan intended to provide integrated, coordinated health care for Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system. Covered areas include physical and behavioral health, pharmacy, intellectual and developmental disabilities services, long-term services and supports, unmet health-related resource needs, and integrated care management. This is a county field-based role in Gaston County, based around Gastonia. The coordinator primarily works in the field, interacting with patients, members, or providers in person four to five days per week, with occasional office attendance for meetings or training. Colocation may require reporting to an office one to three days per week as needed. Travel to the worksite and other locations is required. Candidates must be within a reasonable commuting distance of the posting location and must reside in North Carolina. The role provides integrated, trauma-informed care management and coordinates services across health, behavioral, social, educational, and legal needs. The coordinator works closely with county child welfare workers, members and families, care teams, providers, and other child welfare stakeholders to support members’ needs and permanency planning goals.

Requirements

A BA/BS degree and at least one year of experience working directly with people in the specific program population or in related community-based organizations, or an equivalent combination of education and experience.
Must reside in North Carolina.
Must be within a reasonable commuting distance of the posting location unless an accommodation is granted as required by law.
Ability to work in the field and interact in person with patients, members, or providers four to five days per week.
Ability to travel to the worksite and other locations as necessary.

Nice To Haves

BA/BS degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area.
Two years of experience working directly with individuals served by the child welfare system.

Responsibilities

Provide integrated, whole-person care management under the CFSP Care Management model across physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs.
Provide trauma-informed care, recognizing the role of adverse childhood experiences and coordinating cross-agency support for children’s physical, behavioral, social, educational, and legal needs.
Collaborate with each member’s County Child Welfare Worker to align health care needs with permanency planning goals.
Work with multidisciplinary care teams, including primary health care and behavioral health professionals, specialty providers, and child welfare system stakeholders, to coordinate care.
Conduct telephonic or face-to-face assessments using predefined questions to identify, evaluate, coordinate, and manage member program needs.
Use predefined tools to identify members with potential clinical health care needs and coordinate their cases with clinical health care management and an interdisciplinary team.
Oversee non-clinical needs of members with chronic illnesses, co-morbidities, or disabilities to support cost-effective and efficient service utilization.
Set short- and long-term goals in collaboration with members, caregivers, families, natural supports, and physicians.
Identify members who could benefit from expanded services.
Travel to the worksite and other locations as necessary.