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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator RN Clinician

Medical, Clinical & VeterinaryPosted on Nov 13
Full-timeRichmond, VA, 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 is required, or an equivalent combination of education and experience.
  • A current, active, valid, and unrestricted RN license in applicable state(s) is required.
  • State-specified certification may be required based on state law and/or contract.

Responsibilities

  • Identify members at risk of 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 the member, caregivers, family, natural supports, and physicians.
  • Identify members who may benefit from an alternative level of care or other waiver programs.
  • Develop the member's care plan for services and ensure access to those services, within the scope of RN licensure.
  • Facilitate authorizations or referrals for utilization of services, as appropriate, within the benefits structure or through permissible extra-contractual arrangements.
  • Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on care management treatment plans.
  • Assist with problem-solving provider, claims, or service issues.
  • Direct and oversee LPN/LVN, LSW, LCSW, LMSW, and other licensed non-RN professionals by assigning tasks, verifying and interpreting member information they obtain, conducting additional assessments as necessary, and reviewing and providing input on their performance regularly.
  • Perform telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage members’ physical health, behavioral health, social services, and long-term services and supports needs.
  • Develop, monitor, evaluate, and revise member care plans to meet needs and optimize health care across the care continuum.

Desired Qualifications

  • An associate's, master's, or MS degree in Health or Nursing is preferred.
  • Travel to the worksite and other locations as necessary.

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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