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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-timeOhio, USA

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 strong preference is stated 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 high-risk 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 utilization of health benefits.
  • Obtain a thorough and accurate member history to develop an individual care plan.
  • Establish short- and long-term goals in collaboration with members, caregivers, family, natural supports, and physicians; identify members who could benefit from an alternative level of care or other waiver programs.
  • Develop the member’s care plan for services within the scope of licensure and ensure the member’s access to those services.
  • As appropriate, facilitate authorizations and referrals for utilization of services within the benefits structure or through permissible extra-contractual arrangements to assist with implementing member care plans.
  • Interface with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams on care management and the development of person-centered care plans.
  • Assist with problem solving involving providers, claims, or service issues.

Desired Qualifications

  • A Bachelor of Arts or Bachelor 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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