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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - RN Clinician

Medical, Clinical & VeterinaryPosted on Nov 12
Full-timeIn-person

About the Job

Requirements

  • A high school diploma or equivalent is required.
  • At least 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role is required, or an equivalent combination of education and experience.
  • A current, active, valid, and unrestricted RN license in the applicable state(s) is required.
  • State-specified certification may be required based on state law and/or contract.

Responsibilities

  • Manage members' cases within the scope of licensure and provide direction and oversight to non-RN clinicians participating in a member's case, in accordance with applicable state law and contract.
  • Develop, monitor, evaluate, and revise member care plans to meet members' needs and optimize health care across the care continuum.
  • Perform telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage members' physical health, behavioral health, social services, and long-term services and supports needs.
  • Identify members at risk of complications and coordinate care with members and the health care team.
  • Manage members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits.
  • Obtain thorough and accurate member histories to develop individual care plans.
  • Establish short- and long-term goals in collaboration with members, caregivers, family, natural supports, and physicians.
  • Identify members who may benefit from an alternative level of care or other waiver programs.
  • Develop care plans for member services and ensure members' access to those services.
  • As appropriate, facilitate authorizations and referrals for service utilization within the benefits structure or through permissible extra-contractual arrangements to assist with care plan implementation.
  • Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams to develop care management treatment plans.
  • Assist in resolving provider, claims, or service issues.
  • Direct and oversee LPN/LVN, LSW, LCSW, LMSW, and other licensed non-RN professionals coordinating member services, including assigning tasks, verifying and interpreting member information, conducting additional assessments as needed, developing and revising care plans, and reviewing and providing regular input on non-RN clinicians' performance.
  • Travel to worksites and other locations as necessary.

Desired Qualifications

  • An associate's, master's, or Master of Science degree in Health or Nursing is preferred.

About the Company

Elevance Health

Sells health insurance and pharmacy benefits

Elevance Health is one of the largest U.S. health insurers, covering people through employers, individual plans, Medicare and Medicaid. It is the Blue Cross Blue Shield licensee in 14 states, where it sells plans under the Anthem name, and it runs government plans under the Wellpoint name in other markets. Its Carelon division runs the CarelonRx pharmacy benefit manager and sells behavioral health, care management and other services to its own plans and outside clients. Elevance earns most of its revenue from premiums paid by employers, members and government programs, plus fees for Carelon services. The company is headquartered in Indianapolis, Indiana.

Company size
10,001+
Company stage
IPO
Headquarters
Indianapolis, IN
Founded
1944

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