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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-timeOhio, USAIn-person

About the Job

Requirements

  • A bachelor's degree or equivalent combination of education and experience is required.
  • At least 2 years of experience working with a social work agency is required.
  • Candidates must reside in one of the listed counties in western Ohio.
  • Candidates must be within a reasonable commuting distance of an office unless an accommodation is granted.
  • New candidates in certain patient/member-facing roles must be vaccinated against COVID-19 and influenza unless an acceptable explanation is provided.

Responsibilities

  • Perform face-to-face program assessments using tools with predefined questions to identify needs, applying motivational interviewing techniques for evaluations, coordination, and management of an individual's waiver and behavioral or physical health needs.
  • Use predefined tools and identification processes to identify members with potential clinical healthcare needs, including high-risk complications and gaps in care, and coordinate 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, or disabilities to support cost-effective and efficient use of long-term services and supports.
  • Document members' short- and long-term service and support goals at their direction, in collaboration with their chosen care team, and identify members who may benefit from another service level or waiver program.
  • Submit utilization or authorization requests to utilization management with documentation that supports and aligns with the individual's care plan.
  • Report critical incidents to appropriate internal and external parties, including state and county agencies, Adult Protective Services, and law enforcement.
  • Assist with and participate in appeal or fair hearings, member grievances, appeals, and state audits.
  • Travel to client sites or designated locations as required, with occasional office attendance for meetings or training.

Desired Qualifications

  • Case management experience with older adults or individuals with disabilities is strongly preferred.
  • A bachelor's 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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