Director Special Programs, Clinical Advisory-Healthy Blue Care Together

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.

Sign on Bonus: $7500.00

Location: North Carolina. 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 Director Special Programs, Clinical Advisory is responsible for directing and overseeing the operations of the clinical advisory teams supporting care management for the CFSP, including BH/BH Crisis, Complex Medical, IDD/LTSS/1915i, Transitions of Care, and Family Preservation, with a focus on program performance, operating policies, process improvements, program enhancements, managing interdependencies and risks, program status and evaluation reporting, and growth/expansion.

How You Will Make An Impact

• Directs and oversees program operations in support of corporate and health plan management in execution of clinical service delivery.
• Monitors national and local health plan market trends relative to the clinical span of the program.
• Leads and/or participates in cross-functional workgroups created to maintain and develop clinical programs.
• Evaluates all facets of the clinical program to improve efficiency of operations, financial return, customer service, and provider engagement.
• Develops, communicates, and monitors program schedule, budget, and resources plan; coordinates program deliverables and resolves issues that may hinder clinical program success.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Qualifications

• Requires a BA/BS and minimum of 8 years experience in a related field, including prior management experience and clinical, quality, and/or utilization management experience in a managed care setting; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities And Experiences

• MBA or MHA preferred.
• RN, LSW, or LPN/LVN license strongly preferred.
• Prior experience working managing or leading integrated care management in a LME/MCO, (NC Medicaid Direct or Tailored Plan members) or provider-led Tailored Care Management via an Advanced Medical Home Plus (AMH+) practices or Care Management Agency (CMA).
• Experience and comprehensive understanding of Medicaid services for CWCN (Children With Complex Needs) and SED (Serious Emotional Disturbance), including 1915i and In Reach activities.
• Demonstrated experience in coordinating provider services.

Please 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 Are

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.

How We Work

At 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 [email protected] 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.