Special Programs Case Manager 1 (Complex Medical Clinical Care Advisor)

Elevance Health • Durham, NC

8d • Hybrid

About The Position

The Special Programs Case Manager I (Complex Medical Clinical Care Advisor) supports the Children and Families Specialty Plan’s integrated physical and behavioral health care management teams. The role develops, implements, and coordinates a comprehensive clinical program to support the health and wellness of youth in foster care and adoption assistance, including members with intellectual and developmental disabilities and varying levels of medical and behavioral health complexity and acuity. The position manages healthcare costs, case management, and whole-person health.

This is a field-based position requiring North Carolina residency. Candidates must reside in one of the listed Region 4 counties or within a reasonable commuting distance of a posting office. The role primarily operates in the field, with occasional office attendance for meetings or training; onsite expectations may also be discussed during hiring.

The position works with families, foster parents, service teams, state agencies, and internal and external resources to assess needs, create and coordinate care plans, support access to appropriate care, and address social determinants of health. It may also involve specialty projects, process improvement, staff training and mentoring, case and chart audits, compliance, and participation on the leadership team.

Requirements

• Master’s degree in social work, counseling, or a related behavioral health field, or a nursing degree, with at least 3 years of clinical experience in social work or counseling and broad experience with complex psychiatric and substance-use disorder treatment; an equivalent combination of education and experience may qualify.
• Active, current, and valid license as an RN, LCSW (as applicable by state law and scope of practice), LMHC, LPC (as permitted by applicable state law), LMFT, or Clinical Psychologist to practice within the scope of licensure in applicable U.S. states or territories.
• North Carolina residency is required; candidates must be located in specified Region 4 counties or within a reasonable commuting distance of a posting office.
• Associate-level licenses, including LCSW-A and LCMHC-A, are not accepted.

Nice To Haves

• RN with a complex medical background and Long Term Services and Supports (LTSS) experience.
• Experience serving children, youth, and families through Local Departments of Social Services foster care and adoption assistance programs.
• Certified Case Manager certification.
• Experience managing services for children and youth with complex medical conditions.
• Knowledge of resources, supports, services, and opportunities for safe community living for populations receiving in-reach and transition services, including complex medical and behavioral health services.
• Service delivery coordination, discharge planning, or behavioral health experience in a managed care setting.

Responsibilities

• Collaborate with families, foster parents, and service teams to develop and sustain individualized treatment plans.
• Conduct assessments to identify individual needs.
• Develop comprehensive care plans addressing objectives and goals identified during assessments.
• Support member access to appropriate, quality, and cost-effective care, and modify care plans as needed.
• Coordinate internal and external resources to address members’ integrated physical and behavioral health needs.
• Coordinate social determinants of health and incorporate them into care planning.
• Work closely with state agencies.
• Maintain knowledge of the system-of-care philosophy and coordinated networks of community-based services and supports.
• Build partnerships with designated populations and their families, addressing cultural and linguistic needs.
• Evaluate health needs and identify applicable services and resources with members and their families.
• Provide patient education, medication reconciliation, community-resource identification, and assistance arranging follow-up care.
• Facilitate health rounds with other clinical professionals to support whole-person health.
• Lead or contribute to specialty projects and initiatives.
• Assist with process-improvement activities.
• Train and mentor staff.
• Conduct case and chart audits and ensure departmental compliance.
• Serve as a member of the leadership team.

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 match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level