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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, or an equivalent combination of education and experience.
  • Strong preference for case management experience with older adults or individuals with disabilities.
  • A BA/BS in Health or Nursing is preferred.
  • Candidates must live in one of the listed counties: Cuyahoga, Franklin, Geauga, Huron, Lake, Lorain, Medina, Monroe, Noble, Richland, Washington, Tuscarawas, Carroll, Harrison, Crawford, Seneca, Marion, Coshocton, or Stark.
  • Candidates must be within a reasonable commuting distance of the posting location or an office, unless an accommodation is granted.

Responsibilities

  • Conduct face-to-face program assessments using tools with predefined questions; apply motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver and behavioral or physical health needs.
  • 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 short- and long-term service and support goals in collaboration with members and their chosen care teams, which may include caregivers, family, natural supports, service providers, and physicians; identify members who may benefit from another service level or waiver program.
  • Submit utilization or authorization requests with documentation supporting 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 appeals or fair hearings, member grievances and appeals, and state audits.
  • Travel to client sites or designated locations as required and occasionally attend office meetings or training.

Desired Qualifications

  • Serve as a mentor, subject matter expert, or preceptor for new staff; assist with formal associate training and participate in process-improvement initiatives.

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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