Children and Families Specialty Plan Regional Care Management Director, DSS Region 5

Elevance Health • Durham, NC

3d • Hybrid

About The Position

Children and Families Specialty Plan Regional Care Management Director, DSS Region 5 $5000 Sign-on Bonus Location. Residence in the following NC Counties strongly preferred. Warren, Franklin, Wake, Johnston, Wayne, Wilson, Nash, Halifax, Northampton, Edgecomb, Green and Pitt. This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Children and Families Specialty Plan is looking to hire a Regional Care Management Director to lead the care management team in Medicaid Region 5, in the state of North Carolina. This People Leader will be responsible for the Children and Families Specialty Plan integrated physical health and behavioral health care manager teams and the development, implementation, and coordination of a comprehensive clinical program designed specifically to manage the health and wellness outcomes of youth in foster care and adoption assistance, including highly complex members with varying degrees of medical and behavioral health complexity and acuity. How you will make an impact: Responsible for providing oversight and leadership of Care Management and Care Coordination programs and program operations within one of the six North Carolina Medicaid Regions of the statewide CFSP Care Management model. This responsibility includes required coordination and co-location with local County DSS agencies within the respective regions. Responsible for the overall oversight of the CFSP Care Management teams within assigned regions. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Sets strategy and executes on performance drivers, including alignment with contractual requirements, addressing goals, gaps in care, transitions, social determinates of health (SDOH), and other strategies that support comprehensive, integrated care planning. Supervise and support Care Management Supervisors to lead, develop, and implement clinical and non-clinical activities that impact health care quality cost and outcomes. Coordinates and collaborates with staff of the North Carolina DHHS and its divisions to ensure clinical programs, policies and programs are aligned with member needs. In collaboration with other CFSP team members, develops metrics for monitoring program objectives, policies, and procedures that support regulatory and accreditation standards compliance; identifies training priorities and needs for staff and collaborates to address those priorities and meet the needs; develops and executes population health strategies; Informs network development and provider needs; identifies needs for community and other support programs, resources and linkages. Identifies and develops opportunities for innovation to increase effectiveness and quality. Provide innovative approaches while leading a dedicated team of professionals to work collaboratively to make a difference in the lives of those we serve. Travel within your assigned region is estimated at 25% with periodic overnight travel

Requirements

• Requires a BA/BS and minimum of 8 years experience in a related field, including prior management experience and clinical, quality, and/or utilization management experience in a managed care setting; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Fully licensed clinician (e.g., LCSW, LCMHC, RN, LMFT).
• 5+ years of Care Management/population health experience in a healthcare organization serving Medicaid beneficiaries with a focus on integrated care for children and youth.
• 5+ years of experience working with children, youth and families served by the child welfare system and/or familiarity with the State agencies that are involved with their care (e.g., DSS, Department of Public Instruction, Division of Juvenile Justice and Delinquency Prevention, DMH/DD/SUS).
• Management experience of clinical and non- clinical staff serving the children and youth involved with Juvenile Justice, Social Services, etc.
• Strong leadership and team management skills with a demonstrated ability to develop and implement care management programs.

Responsibilities

• Responsible for providing oversight and leadership of Care Management and Care Coordination programs and program operations within one of the six North Carolina Medicaid Regions of the statewide CFSP Care Management model.
• This responsibility includes required coordination and co-location with local County DSS agencies within the respective regions.
• Responsible for the overall oversight of the CFSP Care Management teams within assigned regions.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• Sets strategy and executes on performance drivers, including alignment with contractual requirements, addressing goals, gaps in care, transitions, social determinates of health (SDOH), and other strategies that support comprehensive, integrated care planning.
• Supervise and support Care Management Supervisors to lead, develop, and implement clinical and non-clinical activities that impact health care quality cost and outcomes.
• Coordinates and collaborates with staff of the North Carolina DHHS and its divisions to ensure clinical programs, policies and programs are aligned with member needs.
• In collaboration with other CFSP team members, develops metrics for monitoring program objectives, policies, and procedures that support regulatory and accreditation standards compliance; identifies training priorities and needs for staff and collaborates to address those priorities and meet the needs; develops and executes population health strategies; Informs network development and provider needs; identifies needs for community and other support programs, resources and linkages.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Provide innovative approaches while leading a dedicated team of professionals to work collaboratively to make a difference in the lives of those we serve.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees