Director Special Programs, Clinical Advisory-Healthy Blue Care Together

Job Overview

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.

$7,500.00

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.

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.

The Director 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. The focus is on program performance, operating policies, process improvements, program enhancements, managing interdependencies and risks, program status and evaluation reporting, and growth/expansion.

• 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 work groups 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.

• 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 providing an equivalent background.

• MBA or MHA preferred.
• RN, LSW, or LPN/LVN license strongly preferred.
• Prior experience 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+) practice 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.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.