RN Delegated Care Management Monitor

Job Description :#HealthyBlueCareTogetherCFSPWe 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. NC RESIDENCY IS REQUIRED$3,500 SIGN ON BONUSLOCATION: This position supports DSS Regions 1 and 2. You must live in one of these regions.HOURS: General business hours, Monday through Friday.TRAVEL: Travel within these regions may be required. When you are not in the field, you will work virtually from your home. 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 Delegated Care Management Monitor (Special Programs Case Manager II) isresponsible for overseeing and monitoring healthcare services to insure quality, compliance, and cost-effectiveness. Coordinate care across providers and settings to improve outcomes and lower costs.Primary responsibilities include, but are not limited to:Review daily reports and performance data to ensure compliance and identify areas for improvement.Manage and control healthcare costs for the designated population through integrated case management.Review member care plans and ensure they are appropriate, high quality, and cost-effective.Coordinate care between delegated care management and internal resources, including social determinants of health, to meet the member's needs and provide patient education.Escalate member crises, or quality of care concerns, as needed.Build relationships with the designated population and their families, addressing cultural and linguistic needs, and coaching the delegated entity to improve overall outcomes.Maintain knowledge of the "system of care" philosophy, which involves a coordinated network of community-based services and supports.May conduct pre-assessment, annual, and ad-hoc audits to evaluate policies, procedures, and documentation.For the State of North Carolina, in accordance with federal/state law, scope of practice regulations or contract, the requirements are: Requires a degree in nursing and minimum of 5 years of clinical experience; or any combination of education and experience which would provide an equivalent background.Requires an active, current and valid license as an RN to practice as a health professional within the scope of licensure in the state of North Carolina.Experience conducting audits and generating compliance reports within a healthcare setting to ensure adherence to regulatory and contractual standards is required.Preferred Qualifications: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 very strongly preferred.Service delivery coordination, discharge planning or behavioral health experience in a managed care setting preferred.Experience with oversight and monitoring of delegated care management services is strongly preferred.Case management certification is preferred.Job Level:Non-Management ExemptWorkshift:1st Shift (United States of America)Job Family:MED > Licensed/Certified Behavioral Health RolePlease 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 AreElevance 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 WorkAt 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 < 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.