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

Elevance Health; Durham (NC); On-site; USD 85,000 - 110,000; Full time

Job summary

Elevance Health, Inc. is seeking a Special Programs Case Manager Lead in North Carolina to coordinate case management for specialty programs (e.g., Foster Care). This field-based role involves coaching, telephonic case management, and occasional home visits as permitted by licensure.

The Lead will manage complex cases, drive workflow improvements, and collaborate with state agencies to deliver integrated physical and behavioral health and whole-person care.

Qualifications

• MS/MA in social work or related field, or nursing degree with 7+ years of clinical experience.
• Active license as RN, LCSW, LMHC, LPC, LMFT, or Clinical Psychologist as required by state law.

Responsibilities

• Conduct assessments to identify individual needs.
• Develop and coordinate comprehensive care plans for integrated (physical and behavioral) health.
• Coordinate with state agencies and community resources for whole-person care.
• Address social determinants of health within care planning.
• Lead specialty projects and mentor staff in case management.
• Perform case management via telephonically and home visits as licensure permits.

Skills

Case management

Leadership

Mentoring

Communication

Home visits

Education

MS/MA in social work or counseling or related behavioral health field

Nursing degree with 7+ years clinical experience

Tools

Licensing (RN/LCSW/LMHC/LPC/LMFT/Clinical Psychologist)

Job description

Special Programs Case Manager Lead

North Carolina residency is required!

Location: State of North Carolina

Field: 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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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 Special Programs Case Manager Lead is 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.

How You Will Make An Impact

• 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.

Minimum Requirements

• 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.

Preferred Skills, Capabilities And Experiences

• 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.