CFSP Managed Care Coordinator - Gaston County

Elevance Health•Gastonia, NC

5d•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 North Carolina’s Children and Families Specialty Plan (CFSP). The CFSP is a statewide Medicaid plan serving Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system. It provides integrated access to physical health, behavioral health, pharmacy, intellectual/developmental disability services, long-term services and supports, unmet health-related resource needs, and integrated care management. This is a county field-based position in Gaston County (Gastonia). The coordinator primarily works in the field, traveling to client sites or other designated locations, and interacts with patients, members, or providers in person four to five days per week. Occasional office attendance may be required for meetings or training. Candidates must be within reasonable commuting distance of the posting location unless an accommodation is granted as required by law. Colocation may require reporting to an office one to three days per week as needed.

Requirements

A BA/BS degree and at least one year of experience working directly with people related to the specific program population or other related community-based organizations, or an equivalent combination of education and experience.
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.
Use trauma-informed care and recognize the role of adverse childhood experiences in the CFSP population while 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.
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 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.