CFSP Managed Care Coordinator - Johnston & Wayne County

Elevance Health•Raleigh, NC

4d•Hybrid

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 role supports Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system, coordinating seamless and integrated health care across 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 field-based role in Johnston and Wayne County, serving the Clayton and Goldsboro areas. Coordinators primarily work in the field and interact in person with patients, members, or providers 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. Candidates must live in North Carolina and within a reasonable commuting distance of the posting location, unless an accommodation is granted as required by law. The position provides trauma-informed, whole-person care management and works closely with county child welfare workers, members, caregivers, families, providers, and multidisciplinary stakeholders to address members’ health and related needs. The role is non-management and non-exempt. The anticipated end date listed for the posting is November 30, 2026.

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 a reasonable commuting distance of the posting location, unless accommodation is granted as required by law.
Ability to work in a field-based role that involves in-person interaction with patients, members, or providers four to five days per week and travel to worksites and other locations as necessary.

Nice To Haves

Bachelor’s degree in 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, intellectual and developmental disability services, 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 care to support 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.
Work with a multidisciplinary care team, 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.
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 related to 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 may benefit from expanded services.
Travel to worksites and other locations as necessary.