Delegated Care Management Monitor (DSS Regions 1/2)

Anticipated End Date:

2025-10-20

Position Title:

Delegated Care Management Monitor (DSS Regions 1/2)

Job Description:

#HealthyBlueCareTogetherCFSP

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!

$2,500 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 monitoring and oversight of delegated care management services. Supports the success of delegated care management services. Manages overall healthcare costs for the designated population via integrated (physical health/behavioral health) case management and whole person health. Serves as subject matter expert for the department.

Primary duties may include, but are not limited to:

• Reviewing care plans and ensuring compliance with the service delivery of the delegated care management partner(s) who are in contract with Healthy Blue.  Partners may include AMH Tier 3’s, Certified Care Management Agencies, and Clinically Integrated Networks. 

• Healthy Blue Care Together (Children and Families Specialty Plan) and its care management partners assign a dedicated care manager to each client, responsible for: comprehensive care management, care coordination, health promotion, transition care, individual and family support, and referral to community services.

• Supports member access to appropriate quality and cost-effective care and modifies plan(s) as needed.

• Reviews daily reports received by the delegated care management partner(s) to ensure compliance to contractual requirements.

• Provides patient education and coordinates with internal and external resources to meet identified needs of the member 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.

• Escalates member crises or quality of care concerns appropriately, according to policy.

• 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.

• Coaches the delegated care management entity to improve overall outcomes for the designated population.

For the State of North Carolina, in accordance with federal/state law, scope of practice regulations or contract, the requirements are:

• Requires MS/MA in social work, counseling, or a related behavioral health field, or a degree in nursing and minimum of 5 years of clinical experience in social work counsel