E

Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - Registered Nurse Clinician

Medical, Clinical & VeterinaryPosted on Nov 13
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.
  • An associate's, master's, or MS in Health/Nursing is preferred.
  • The role requires travel to the worksite and other locations as necessary.

Responsibilities

  • Manage members' cases within the scope of licensure and provide direction and oversight to non-RN clinicians participating in each member's case in accordance with applicable state law and contract.
  • Develop, monitor, evaluate, and revise member care plans to meet 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 service, 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 service care plans for members and ensure their access to those services.
  • Assist with implementing member care plans by facilitating service authorizations and referrals within the benefit structure or through permissible extra-contractual arrangements, as appropriate.
  • 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 by assigning appropriate tasks, verifying and interpreting member information they obtain, conducting additional assessments as needed, developing and revising care plans, and regularly reviewing and providing input on their performance.

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

Recently Posted Jobs

Explore more opportunities at Elevance Health

See more jobs