Clinical Care Advisor - Complex Medical Healthy Blue Care Together CFSP

Anticipated End Date:

Position Title:

Clinical Care Advisor - Complex Medical Healthy Blue Care Together CFSP

Job Description:

#Healthy Blue Care Together CFSP

$3,500 SIGN ON BONUS

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.

North Carolina residency is required!

• Region 6 counties:
  Bladen, Brunswick, Carteret, Columbus, Craven, Cumberland, Duplin, Jones, Lenoir, New Hanover, Onslow, Pamlico, Pender, Perquimans, and Sampson
• Region 7 counties:
  Beaufort, Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford, Hyde, Martin, Pasquotank, Perquimans, Tyrrell, and Washington.

Travel within your assigned DSS Region is required. When you are not in the field, you will work virtually from your home. These roles are statewide field-based and requires you to interact with patients, members, or providers in person four to five days per week. This is a collaborative role with the field care managers for the CFSP program with the advisors supporting the care managers with consulting on complex medical or IDD cases.

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 Clinical Care Advisor - Complex Medical 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 highly complex members with varying degrees of medical and behavioral health complexity and acuity.

Manages overall healthcare costs, case management and whole person health.

• 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.
• Works 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…