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

• Region 5 counties: Edgecombe, Franklin, Granville, Halifax, Johnston, Nash, Northampton, Pitt, Vance, Wake, Warren, Wayne, Wilson, Greene
  

• 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.
  

• 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.
  

• 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.
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

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.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 View email address on us.fitly.work 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