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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - Case Manager

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeIn-person

About the Job

Requirements

  • A BA/BS degree and at least 2 years of experience working with a social work agency are required, or an equivalent combination of education and experience.
  • Specific education, years, and type of experience may be required based on state law and contract requirements.

Responsibilities

  • Conduct face-to-face program assessments using tools with predefined questions to identify member needs, applying motivational interviewing techniques for evaluation, coordination, and management of waiver and behavioral or physical health needs.
  • Identify members with potential clinical health care needs using tools and predefined processes, including potential high-risk complications and gaps in care, and coordinate their cases as the single point of contact with clinical healthcare management and the interdisciplinary team.
  • Manage members’ non-clinical needs related to chronic illnesses, comorbidities, and disabilities to support cost-effective and efficient use of long-term services and supports.
  • Document members’ short- and long-term service and support goals in collaboration with the member and their chosen care team, which may include caregivers, family, natural supports, service providers, and physicians.
  • Identify members who may benefit from an alternative service level or other waiver programs.
  • May serve as a mentor, subject matter expert, or preceptor for new staff and assist in formal associate training; may participate in process improvement initiatives.
  • Submit utilization or authorization requests to utilization management with documentation supporting and aligning with the individual’s care plan.
  • Report critical incidents to appropriate internal and external parties, including state and county agencies such as Adult Protective Services and law enforcement.
  • Assist with and participate in appeal or fair hearings, member grievances and appeals, and state audits.

Desired Qualifications

  • A BA/BS degree in a health care-related field of study is preferred.
  • Bilingual ability in English and Spanish is strongly preferred.
  • Experience in long-term services and supports, case management, social work, or hospital discharge planning 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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