Licensed Delegated Care Management Monitor (DSS Regions 1/2) at Elevance Health

Asheville, North Carolina, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

NoVisa

Healthcare, Medicaid, Child WelfareIndustries

Requirements

NC residency required and must live in DSS Regions 1 or 2
Degree in nursing and minimum of 5 years of clinical experience, or any combination of education and experience providing equivalent background
Active, current, and valid license as an RN to practice as a health professional within the scope of licensure in North Carolina
Experience conducting audits and generating compliance reports within a healthcare setting to ensure adherence to regulatory and contractual standards
Preferred: Experience working with Children, Youth, and Families served by Local Departments of Social Services through Foster Care and Adoptive Assistance programs
Preferred: Service delivery coordination, discharge planning, or behavioral health experience

Responsibilities

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, involving a coordinated network of community-based services and supports
May conduct pre-assessment, annual, and ad-hoc audits to evaluate policies, procedures, and documentation

Skills

Key technologies and capabilities for this role

Care ManagementHealthcare ComplianceQuality AssuranceCase ManagementMedicaidChild WelfareBehavioral HealthLong Term Services and SupportsMonitoringCoordination

Questions & Answers

Common questions about this position

Is there a sign-on bonus for this position?

Yes, there is a $3,500 sign-on bonus available.

What are the location and travel requirements for this role?

NC residency is required, and you must live in DSS Regions 1 or 2. The role is field-based with travel within these regions required, and virtual work from home when not in the field.

What are the main responsibilities of this role?

The role involves reviewing daily reports and performance data for compliance, managing healthcare costs through integrated case management, reviewing member care plans, coordinating care, escalating crises, building relationships with families, and maintaining knowledge of the system of care philosophy.

What is the work schedule for this position?

The hours are general business hours, Monday through Friday.

What qualifications make a strong candidate for this role?

Strong candidates should have experience in care management, knowledge of healthcare compliance and cost management, ability to coordinate care across providers, and skills in building relationships with families while addressing cultural and linguistic needs; the position requires a license as indicated by the title.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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