Director Special Programs-Clinical Advisory

Elevance Health • Greensboro, NC

17h • Hybrid

About The Position

We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system so that they receive seamless, integrated, and coordinated health care. Within the Children and Families Specialty Plan (CFSP), and regardless of where a member lives, they will have access to the same basic benefits and services, including Physical health, Behavioral health, Pharmacy, Intellectual/Developmental Disabilities (I/DD) services, long term services and supports, Unmet health-related resource needs, and Integrated care management. We envision a North Carolina where all children and families thrive in safe, stable, and nurturing homes. Sign on Bonus: $7500.00 Director Special Programs-Clinical Advisory The Director Special Programs-Clinical Advisory is responsible for directing and overseeing the operations of the clinical advisory teams supporting care management for the CFSP, including BH/BH Crisis, Complex Medical, IDD/LTSS/1915i, Transitions of Care, and Family Preservation, with a focus on program performance, operating policies, process improvements, program enhancements, managing interdependencies and risks, program status and evaluation reporting, and growth/expansion. Location: North Carolina. 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.

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

• MBA or MHA preferred.
• RN, LSW, or LPN/LVN license strongly preferred.
• Prior experience working managing or leading integrated care management in a LME/MCO, (NC Medicaid Direct or Tailored Plan members) or provider-led Tailored Care Management via an Advanced Medical Home Plus (AMH+) practices or Care Management Agency (CMA).
• Experience and comprehensive understanding of Medicaid services for CWCN (Children With Complex Needs) and SED (Serious Emotional Disturbance), including 1915i and In Reach activities.
• Demonstrated experience in coordinating provider services.

Responsibilities

• Directs and oversees program operations in support of corporate and health plan management in execution of clinical service delivery.
• Monitors national and local health plan market trends relative to the clinical span of the program.
• Leads and/or participates in cross-functional workgroups created to maintain and develop clinical programs.
• Evaluates all facets of the clinical program to improve efficiency of operations, financial return, customer service, and provider engagement.
• Develops, communicates, and monitors program schedule, budget, and resources plan; coordinates program deliverables and resolves issues that may hinder clinical program success.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

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