CFSP Managed Care Coordinator - Nash County

Elevance Health•Raleigh, NC

3d•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 designed to provide coordinated health care to Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system. The plan integrates physical health, behavioral health, pharmacy, intellectual and developmental disability services, long-term services and supports, unmet health-related resource needs, and care management. This is a field-based role in Nash County, with in-person interaction with patients, members, or providers four to five days per week. The coordinator travels to client sites or other designated locations as needed, with occasional office attendance for meetings or training. The role provides integrated, whole-person care management using a trauma-informed approach, working with members, caregivers, families, child welfare workers, healthcare professionals, and other stakeholders.

Requirements

A BA/BS degree and at least 1 year of experience working directly with people related to the specific program population or in other related community-based organizations, or an equivalent combination of education and experience.
Must reside in North Carolina.
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, coordinating physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs.
Apply trauma-informed care by 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 healthcare needs with permanency planning goals.
Work with multidisciplinary care teams, including primary care and behavioral health professionals, specialty providers, and child welfare 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 healthcare needs using predefined tools and coordinate cases with clinical healthcare 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 could benefit from expanded services.