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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - RN Clinician, RN Case Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-time

About the Job

Requirements

  • Requires an RN and a minimum of 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or an equivalent combination of education and experience.
  • A current, unrestricted RN license in applicable state(s) is required.
  • State-specified certification may be required based on state law and/or contract.

Responsibilities

  • Manage each member's case within the scope of licensure and develop, monitor, evaluate, and revise the member's care plan to meet needs and optimize healthcare across the care continuum.
  • Perform 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.
  • Identify members at risk for complications and coordinate care with the member and healthcare team.
  • Manage members with chronic illnesses, co-morbidities, and/or disabilities to support cost-effective and efficient utilization of health benefits.
  • Obtain an accurate member history to develop an individual care plan.
  • Establish short- and long-term goals with members, caregivers, family, natural supports, and physicians; identify members who may benefit from an alternative level of care or other waiver programs.
  • Develop the care plan for member services and ensure members' access to those services.
  • As appropriate, facilitate authorizations and referrals for services within the benefits structure or through permissible extra-contractual arrangements to help implement care plans.
  • Interface with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams to develop care management treatment plans.
  • Help resolve provider, claims, or service issues as needed.
  • Direct and/or supervise non-RN clinicians, including LPNs/LVNs, LSWs, LCSWs, and LMSWs, by assigning tasks, verifying and interpreting information they obtain, conducting additional assessments as needed, and reviewing and providing input on their performance regularly.
  • Travel to the worksite and other locations as necessary.

Desired Qualifications

  • A Master of Arts or Master of Science 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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