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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - RN Clinician, RN Case Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-time

About the Job

Requirements

  • A high school diploma or GED equivalent and 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, or an equivalent combination of education and experience.
  • A current, active, valid, and unrestricted registered nurse license in Ohio is required.
  • A Bachelor of Arts or Bachelor of Science in Health or Nursing is preferred but not required.
  • Strong preference for case management experience with older adults or individuals with disabilities.

Responsibilities

  • Perform telephonic and face-to-face functional 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 the member and health care team.
  • Manage members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient use of health benefits.
  • Obtain a thorough and accurate member history to develop an individual care plan.
  • Establish short- and long-term goals with members, caregivers, family, natural supports, and physicians; identify members who may benefit from an alternative level of care or other waiver programs.
  • Develop service care plans for members within the scope of nursing licensure and ensure members’ access to those services.
  • Assist with implementing member care plans by facilitating service authorizations or referrals within the benefits structure or through permissible extra-contractual arrangements, as appropriate.
  • Coordinate with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams to develop person-centered care management plans.
  • Assist with problem-solving provider, claims, or service issues.

Desired Qualifications

  • Case management experience with older adults or individuals with disabilities.

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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