CFSP Managed Care Coordinator - Graham County

Elevance Health • Robbinsville, NC

11d • 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. The role supports North Carolina’s Children and Families Specialty Plan, coordinating integrated care for Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system.

This field-based position is based in Graham County (Robbinsville), with in-person interaction with patients, members, or providers four to five days per week and occasional office attendance for meetings or training. Associates may need to report 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; North Carolina residency is required. Travel to worksites and other locations is necessary.

The coordinator provides whole-person care management across physical health, behavioral health, intellectual and developmental disability services, long-term services and supports, pharmacy, and unmet health-related needs. The role uses trauma-informed care and works with families, caregivers, county child welfare workers, health care professionals, and other stakeholders to coordinate services and support members’ goals.

Requirements

• Bachelor of Arts or Bachelor of Science degree 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.
• Must be able to travel to worksites and other locations as necessary.
• Must be within reasonable commuting distance of the posting location unless an accommodation is granted as required by law.

Nice To Haves

• Bachelor of Arts or Bachelor of Science 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 across physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs.
• Apply trauma-informed care, recognizing the role of ACEs and coordinating cross-agency support for children’s 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 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 health care needs using predefined tools 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 could benefit from expanded services.
• Travel to worksites and other locations as necessary.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical benefits
• Dental benefits
• Vision benefits
• Short- and long-term disability benefits
• 401(k) with company match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time