Special Programs Case Manager Lead (1915i/IDD Team)

Elevance Health•Durham, NC

15h•Hybrid

About The Position

The Special Programs Case Manager Lead coordinates operations and workflows related to case management activities supporting specialty programs, such as Foster Care. This role serves as a coach, conducts case management by telephone and/or home visits within the scope of licensure, manages overall healthcare costs for a designated population through integrated physical and behavioral health case management and whole-person health, and handles the most complex cases while supporting Special Programs case managers. The role is field-based in North Carolina, with travel to client sites or designated locations as required and occasional office attendance for meetings or training. North Carolina residency is required. Candidates must live within a reasonable commuting distance of an office unless an accommodation is granted as required by law. The Case Manager Lead assesses individual needs, develops and adjusts comprehensive care plans, coordinates integrated care and social determinants of health, and connects members and families with appropriate services and resources. The role works closely with state agencies and clinical professionals, supports member education and follow-up care, and helps build partnerships that address cultural and linguistic needs. The position may lead specialty projects and process improvement activities, and also trains and mentors staff, conducts case and chart audits, ensures departmental compliance, and serves on the leadership team.

Requirements

Master's degree in social work, counseling, or a related behavioral health field, or a nursing degree, and at least 7 years of clinical experience in social work counseling with broad experience in complex psychiatric and substance abuse or substance use disorder treatment; or an equivalent combination of education and experience.
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.

Nice To Haves

Experience working with specialty populations.
Clinical social work or counseling experience across a broad range of complex psychiatric/substance abuse and/or medical disorders.

Responsibilities

Coordinate operations and workflows related to case management activities for specialty programs, such as Foster Care.
Coach and support Special Programs case managers, and manage the most complex cases.
Conduct case management by telephone and/or home visits within the scope of licensure.
Manage healthcare costs for the designated population through integrated physical and behavioral health case management and whole-person health.
Assess individual needs and develop comprehensive care plans with objectives and goals; support access to quality, cost-effective care and modify plans as needed.
Coordinate internal and external resources to meet 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 meaningful 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.
May lead and work on 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.