CFSP Managed Care Coordinator - Haywood County

Elevance Health•Fairview, NC

6d•Onsite

About The Position

The CFSP Managed Care Coordinator manages members’ individual service plans within the scope of the NC 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 integrated care across physical health, behavioral health, pharmacy, intellectual/developmental disability services, long-term services and supports, unmet health-related resource needs, and care management. This is a field-based role in Haywood County (Waynesville). The coordinator primarily works in the field, visiting client sites or designated locations, and interacts in person with patients, members, or providers four to five days per week. Occasional office attendance may be needed for meetings or training. The role requires travel to the worksite and other locations as necessary, and candidates must reside in North Carolina and be 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 1 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.
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.
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 a multidisciplinary team of primary health care and behavioral health professionals, specialty providers, and child welfare stakeholders, including coordination involving juvenile justice awareness.
Conduct telephonic or face-to-face assessments using predefined questions to identify, evaluate, coordinate, and manage member program needs.
Use predefined tools to identify members with potential clinical health care needs and coordinate their 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 would benefit from expanded services.