RN Delegated Care Management Monitor (DSS Regions 1/2)

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.

We 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 BONUS LOCATION: 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) is responsible 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.

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.