CFSP Managed Care Coordinator - Pitt County

Elevance Health•Durham, NC

11d•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 state law and contract. The CFSP is a statewide Medicaid plan developed with North Carolina DHHS to provide coordinated 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 disability services, long-term services and supports, unmet health-related resource needs, and integrated care management. This is a county field-based role in Pitt County (Greenville), with in-person interaction with patients, members, or providers four to five days per week. The role involves travel to client sites or other designated locations, with occasional office attendance for meetings or training. Colocation may require reporting to an office one to three days per week as needed. Applicants must live in North Carolina and within reasonable commuting distance of the posting location unless an accommodation is granted as required by law.

Requirements

Bachelor’s degree (BA/BS) and at least one year of experience working directly with people related to the specific program population or with other related community-based organizations, or an equivalent combination of education and experience.
Must reside in North Carolina.
Must be within reasonable commuting distance of the posting location unless an accommodation is granted as required by law.

Nice To Haves

Bachelor’s 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, coordinating 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 members’ 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.
Coordinate care with a multidisciplinary team, including primary care and behavioral health professionals, specialty providers, and child welfare stakeholders.
Conduct telephonic or face-to-face assessments using predefined questions to identify, evaluate, coordinate, and manage member program needs.
Identify members with potential clinical health care needs using predefined tools and coordinate cases with clinical health care management and an interdisciplinary team.
Oversee members’ non-clinical needs when they have chronic illnesses, co-morbidities, or disabilities, supporting 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.