CFSP Managed Care Coordinator - Cumberland County

Elevance Health•Raleigh, NC

5d•Onsite

About The Position

The CFSP Managed Care Coordinator is responsible for overall management of members’ individual service plans within the scope of the role in the North Carolina Children and Families Specialty Plan (CFSP), as required by applicable state law and contract. The CFSP is a statewide Medicaid plan designed to support Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system through seamless, integrated, and coordinated health care. Services include physical health, behavioral health, pharmacy, intellectual and 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 Cumberland County (Fayetteville). The role primarily operates in the field, traveling to client sites or designated locations, and requires in-person interaction with patients, members, or providers four to five days per week. Occasional office attendance may be needed for meetings or training; colocation may require reporting to an office one to three days per week as needed. Candidates must be within reasonable commuting distance of the posting location unless an accommodation is granted as required by law. Elevance Health partners with North Carolina DHHS on the CFSP, with the vision of helping children and families thrive in safe, stable, and nurturing homes.

Requirements

Bachelor’s degree (BA/BS) 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 worksites 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.
Ability to report to an office location one to three days per week as needed if colocation is required.

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 adverse childhood experiences and coordinating cross-agency care 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, including primary health care and behavioral health professionals, specialty providers, and child welfare system stakeholders.
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 with members, caregivers, families, natural supports, and physicians.
Identify members who may benefit from expanded services.
Travel to worksites and other locations as necessary.