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

Elevance Health•Durham, NC

7d•Hybrid

About The Position

The Special Programs Case Manager I (Complex Medical Clinical Care Advisor) supports integrated physical and behavioral health care management for children and families in specialty programs. The role develops, implements, and coordinates clinical programs intended to improve health and wellness outcomes for youth in foster care and adoption assistance, including members with intellectual and developmental disabilities and varying levels of medical and behavioral health complexity. It also manages healthcare costs, case management, and whole-person health. This field-based position requires North Carolina residency, with candidates located in specified Region 4 DSS counties. Associates primarily work in the field, traveling to client sites or designated locations, with occasional office attendance for meetings or training. The role collaborates with families, foster parents, service teams, state agencies, and clinical professionals to assess needs, create and coordinate individualized care plans, connect members with appropriate resources, and support follow-up care. The position may also support specialty initiatives and process improvements, train and mentor staff, conduct case and chart audits, ensure departmental compliance, and serve on the leadership team.

Requirements

A master’s degree in social work, counseling, or a related behavioral health field, or a degree in nursing, and at least 3 years of clinical experience in social work or counseling, including broad experience with complex psychiatric and substance-use treatment; an equivalent combination of education and experience may be accepted.
An active, current, and valid license as an RN, LCSW (as applicable by state law and scope of practice), LMHC, LPC (as allowed by applicable state laws), 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 reside in the specified Region 4 North Carolina DSS counties or within a reasonable commuting distance from an office; candidates outside a reasonable commuting distance will not be considered unless an accommodation is granted as required by law.
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 working with children, youth, and families served by Local Departments of Social Services through foster care and adoptive assistance programs.
Certified Case Manager certification.
Experience managing service delivery 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 create and sustain individualized treatment plans.
Conduct assessments to identify individual needs and develop comprehensive care plans with objectives and goals.
Support access to appropriate, quality, and cost-effective care, modifying 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 community-based services and supports.
Build partnerships with designated populations and families, addressing cultural and linguistic needs.
Evaluate health needs and identify applicable services and resources with members and families.
Provide patient education, medication reconciliation, community-resource information, and assistance arranging follow-up care.
Facilitate health rounds with other clinical professionals to support whole-person health.
Lead or participate in specialty projects and initiatives.
Assist with process-improvement activities.
Train and mentor staff.
Perform case and chart audits and ensure departmental compliance.
Serve as a member of the leadership team.