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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - RN Clinician

Medical, Clinical & VeterinaryPosted on Nov 13
Full-timeIndianapolis, IN, USAIn-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, or an equivalent combination of education and experience, is required.
  • 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.
  • Travel to the worksite and other locations as necessary is required.

Responsibilities

  • Identify members at risk of high-risk complications and coordinate their care with the member and health care team.
  • Manage members with chronic illnesses, co-morbidities, and/or disabilities to support cost-effective and efficient use of health benefits.
  • Obtain a thorough and accurate member history and develop an individual care plan.
  • 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 the care plan for member services and ensure the member's access to those services.
  • As appropriate, facilitate authorizations and referrals for services within the benefits structure or through permissible extra-contractual arrangements to help implement member care plans.
  • Coordinate with Medical Directors, Physician Advisors, and interdisciplinary teams to develop care management treatment plans.
  • Help solve provider, claims, or service issues as needed.
  • Provide direction and oversight to LPN/LVN, LSW, LCSW, LMSW, and other non-RN licensed professionals coordinating member services. Assign appropriate tasks, verify and interpret information they obtain, conduct additional assessments as needed, develop, monitor, evaluate, and revise member care plans, and review and provide input on their performance regularly.

Desired Qualifications

  • An associate, MA, or MS degree in Health/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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