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

Elevance Health•Durham, NC

5d•Hybrid

About The Position

The Special Programs Case Manager I (Complex Medical Clinical Care Advisor) is responsible for the Children and Families Specialty Plan integrated physical health and behavioral health care management 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 Intellectual & Developmental Disabilities (IDD) members with varying degrees of medical and behavioral health complexity and acuity. Manages overall healthcare costs, case management and whole person health. 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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. North Carolina residency is required! We are currently seeking people in the following North Carolina DSS counties: Region 5 counties: Edgecombe, Franklin, Granville, Halifax, Johnston, Nash, Northampton, Pitt, Vance, Wake, Warren, Wayne, Wilson, Greene

Requirements

Requires MS/MA in social work, counseling, or a related behavioral health field or a degree in nursing and minimum of 3 years of clinical experience in social work counseling with broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience, which would provide an equivalent background.
Requires 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 as a health professional within the scope of licensure in applicable states or territory of the United States.

Nice To Haves

RN with Complex Medical background with Long Term Services and Supports (LTSS) experience highly preferred.
Experience working with Children, Youth, and Families who are being served by Local Departments of Social Services through Foster Care and Adoptive Assistance programs is strongly preferred.
Certified Case Manager Certification strongly preferred.
Experience serving the children and youth involved in Foster Care and Social Services is strongly preferred.
Prior experience in managing the delivery of services to meet the needs of children and youth with complex medical conditions is strongly preferred.
Knowledge of resources, supports, services and opportunities required for safe community living for populations receiving in-reach and transition services, including Complex Medical and Behavioral Health is strongly preferred.
Service delivery coordination, discharge planning or behavioral health experience in a managed care setting preferred.
We are unable to accommodate LCSW-A, LCMHC-A or any other associate level licenses.

Responsibilities

Engage collaboratively with key stakeholders, including families, foster parents, and service teams—to craft and sustain individualized treatment plans.
Conducts assessments to identify individual needs.
Develops comprehensive care plan to address objectives and goals as identified during assessment.
Supports member access to appropriate quality and cost-effective care and modifies plan(s) as needed.
Coordinates with internal and external resources to meet identified needs of the member in terms of integrated (physical and behavioral) whole person care.
Coordinates social determinants of health to meet the needs of the member and incorporates that into care planning.
Work closely with various state agencies.
Maintains knowledge of the system of care philosophy; a spectrum of effective, community-based services and supports for those with or at risk for mental health or other challenges and their families, that is organized into a coordinated network.
Builds meaningful partnerships with designated populations and their families, and addresses cultural and linguistic needs, in order to help them function better at home, in the community, and throughout life.
Evaluates health needs and identifies applicable services and resources in conjunction with members and their families.
Provides important information including patient education, medication reconciliation, and identification of community resources and assists with arrangement of follow-up care.
Facilitates health rounds with other clinical centered professionals to ensure whole person health.
May lead and work on specialty projects and initiatives.
Assists with process improvements activities.
Trains and mentors staff.
Performs case/chart audits and ensures departmental compliance.
Serves as a member of the leadership team.