Special Programs Case Mgr Ld

Elevance Health; Cary, Northern (NC, KY); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Elevance Health seeks a health professional to coordinate case management for specialty programs, including Foster Care. The role involves telephonic and home-visit care, development of care plans, and collaboration with state agencies to provide integrated physical and behavioral health services.

The candidate must hold MSW/MA in social work or nursing with 7+ years of clinical experience and an active license, reside in NC or within 40 miles, and be able to work in Elevance Health's hybrid

Qualifications

• 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.
• 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.

Responsibilities

• Coordinates case management activities for Foster Care and other specialty programs, including telephonic and home visits.
• Develops comprehensive care plans and coordinates with internal and external resources.
• Supports access to quality, cost-effective care and conducts health rounds with clinical staff to ensure whole person care.
• Trains and mentors staff; leads and works on specialty projects and initiatives.
• Ensures compliance through case/chart audits and participates in leadership activities.

Skills

Communication skills

Clinical judgment

Coaching/mentoring

Education

MSW / MA in social work or related behavioral health field

Nursing degree (RN)

Job description

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.

Primary duties may include, but are not limited to:

• 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.

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.
• 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 Government business only, LAPC, LAMFT, LMSW (as allowed by applicable state laws) is also acceptable in addition to other licensure referenced above; and any other state or federal requirements that may apply.
• Travels to worksite and other locations as necessary.
• Work Schedule: Normal business hours, M-F, 8:30-5pm EST.
• Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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. Candidates must be within a reasonable commute to a PulsePoint location.

Work Locations

• Region 1: 2 positions
• Region 2: 1 position
• Region 3: 1 position
• Region 4: 2 positions
• Region 5: 1 position
• Region 6/7: 1 position

About BCForward

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.