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Elevance Health

Sells health insurance and pharmacy benefits

Family Care-Service Coordinator

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeWaukesha, WI, USA

About the Job

Requirements

  • A Bachelor of Arts or Bachelor of Science degree and at least 2 years of experience working with a social work agency, or an equivalent combination of education and experience.
  • Travel to the worksite and other locations as necessary.
  • New candidates in certain patient/member-facing roles must be vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided.

Responsibilities

  • Conduct 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.
  • Identify members with potential clinical health care needs, including high-risk complications and gaps in care, and coordinate cases as the single point of contact with clinical health care management and the interdisciplinary team.
  • Manage members' non-clinical needs related to chronic illnesses, comorbidities, and 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 the member's direction and in collaboration with the chosen care team, which may include caregivers, family, natural supports, service providers, and physicians.
  • Submit utilization or authorization requests to utilization management with documentation aligned with the individual's care plan.
  • Report critical incidents to appropriate internal and external parties, including state and county agencies such as Adult Protective Services and law enforcement.
  • Assist with and participate in appeal or fair hearings, member grievances and appeals, and state audits.
  • May mentor, serve as a subject matter expert or preceptor for new staff, and assist in formal associate training.
  • May participate in process improvement initiatives.

Desired Qualifications

  • A BA/BS degree in a health care-related field of study.
  • Assisted living or social work experience.
  • Waiver experience.
  • Comfort using technology.

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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