CFSP Managed Care Coordinator - Johnston & Wayne County

Elevance Health•Goldsboro, NC

5d•Hybrid

About The Position

The CFSP Managed Care Coordinator is responsible for overall management of members’ individual service plans within the scope of the position and in accordance with applicable state law and contract. The role supports North Carolina’s Children and Families Specialty Plan (CFSP), 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. This is a county field-based position serving Johnston and Wayne County (Clayton/Goldsboro). The coordinator primarily works in the field, traveling to client sites or designated locations and interacting with members, patients, or providers in person four to five days per week. Occasional office attendance may be required for meetings or training; colocation may also require reporting to an office one to three days per week as needed. Candidates must live 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; an equivalent combination of education and experience is acceptable.
Must reside in North Carolina.
Ability to travel to 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.
Provide trauma-informed care, recognizing the role of ACEs 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 health care and behavioral health professionals, specialty providers, and child welfare stakeholders, with awareness of juvenile justice coordination.
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.
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 the worksite and other locations as necessary.