CFSP Managed Care Coordinator - Pitt County

Elevance Health•Durham, NC

12d•Hybrid

About The Position

The CFSP Managed Care Coordinator manages members’ individual service plans within the scope of the position and in accordance with applicable state law and contract requirements for the North Carolina Children and Families Specialty Plan (CFSP). The CFSP supports Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system with integrated, coordinated health care, including physical health, 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 serving Pitt County, based in the Greenville area. Coordinators primarily work in the field and interact in person with patients, members, or providers four to five days per week, traveling to client sites or designated locations as needed, with occasional office attendance for meetings or training. Colocation may require reporting to an office one to three days per week as needed. Candidates must live within a reasonable commuting distance of the posting location unless an accommodation is granted as required by law. The coordinator provides trauma-informed, whole-person care management and partners with members, families, caregivers, county child welfare workers, health care providers, and other stakeholders to coordinate services and support members’ needs and goals. The role is classified as Non-Management Non-Exempt in the Care Coordination and Care Management (Non-Licensed) job family.

Requirements

Bachelor’s degree or equivalent combination of education and experience providing an equivalent background.
At least one year of experience working directly with people related to the specific program population or with other related community-based organizations.
Must reside in North Carolina.
Must be within a reasonable commuting distance of the posting location unless 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 across physical health, behavioral health, intellectual and developmental disabilities, long-term services and supports, 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 multidisciplinary teams, including primary care and behavioral health professionals, specialty providers, and child welfare system 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 non-clinical needs of members with chronic illnesses, co-morbidities, or disabilities to support cost-effective and efficient service utilization.
Establish short- and long-term goals with members, caregivers, families, natural supports, and physicians.
Identify members who may benefit from expanded services.
Travel to the worksite and other locations as necessary.