Special Programs Case Mgr Ld

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

"The use of this job is limited to GBD business units working on the Foster Care special program. If you believe this to be the best match for your position, please consult with your Human Resources partner prior to using this job (HRBP should work with Compensation).

Responsible for coordinating operations and workflows related to case management activities in support of specialty programs, such as Foster Care. Serves as coach. Performs case management telephonically and/or by home visits within the scope of licensure. Manages overall healthcare costs for the designated population via integrated (physical health/behavioral health) case management and whole person health. Manages the most complex cases and provides support to Special Programs case managers.

• 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 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.

• Requires MS/MA in social work, counseling, or a related behavioral health field or a degree in nursing and minimum of 7 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 required.
• Must reside in NC as they will be in the field, or within 40 miles of NC border.
• Must Have requirement: 1915(i) knowledge and experience means demonstrated understanding of Medicaid 1915(i) Home and Community-Based Services (HCBS), including eligibility and assessment requirements, person-centered planning, service coordination, provider collaboration, and the use of community-based supports to help individuals with complex I/DD and behavioral health needs remain safely in the community and avoid unnecessary institutional or facility-based care.
• Current or prior experience with an LME/MCO in NC;
  Or with a 1915i service provider - mandatory.
• Experience working with specialty populations preferred.
• Clinical experience in social work counseling with a broad range of complex psychiatric/substance abuse and/or medical disorders preferred.
• For…