CFSP Managed Care Coordinator

Elevance Health • Murphy, NC

36d • Hybrid

About The Position

CFSP Managed Care Coordinator We are currently seeking people in the following counties and look forward to speaking with you! (Alexander, Alleghany, Watauga, Cherokee, Clay, Graham, and Transylvania) Location: Field: This field-based role in Cherokee County (Murphy), enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. These roles are statewide field-based and requires you to interact with patients, members, or providers in person four to five days per week. We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system so that they receive seamless, integrated, and coordinated health care. Within the Children and Families Specialty Plan (CFSP), and regardless of where a member lives, they will have access to the same basic benefits and services, including Physical health, Behavioral health, Pharmacy, Intellectual/Developmental Disabilities (I/DD) services, long term services and supports, Unmet health-related resource needs, and Integrated care management. We envision a North Carolina where all children and families thrive in safe, stable, and nurturing homes. The CFSP Managed Care Coordinator is responsible for the overall management of the member's individual service plan within the scope of position in the NC CFSP Program, as required by applicable state law and contract.

Requirements

• Requires BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• Must reside in North Carolina.
• BA/BS degree preferred in a field related to health, psychology, sociology, social work, nursing or another relevant human services area.
• Two (2) years of experience working directly with individuals served by the child welfare system is preferred.
• Travels to worksite and other locations as necessary.

Responsibilities

• Provide integrated whole-person Care Management under the CFSP Care Management model, including coordination across physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs.
• Offer Trauma-Informed Care by recognizing the role of ACEs in the CFSP population and coordinating cross-agency care to support children's diverse needs, including physical, behavioral, social, educational, and legal aspects.
• Collaborate closely 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 stakeholders in the child welfare system, to coordinate care (e.g., coordination involving juvenile justice awareness).
• 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, coordinating their cases with clinical healthcare management and an interdisciplinary team for care coordination support.
• Oversee non-clinical needs of members with chronic illnesses, co-morbidities, or disabilities for 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 would benefit from expanded services.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Number of Employees: 5,001-10,000 employees