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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - RN Clinician

Medical, Clinical & VeterinaryUpdated on Nov 10
Full-timeIn-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 registered nurse license in applicable state(s) is required.
  • State-specified certification may be required based on state law and/or contract.
  • The candidate should reside in Passaic County, New Jersey.
  • Candidates must be within a reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law.
  • Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and influenza unless they provide an acceptable explanation.

Responsibilities

  • Manage members' cases within the scope of licensure and provide direction and oversight to non-RN clinicians participating in each case in accordance with applicable state law and contract.
  • Develop, monitor, evaluate, and revise members' care plans to meet their needs and optimize healthcare across the care continuum.
  • 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.
  • Identify members at risk of high-risk complications and coordinate care with members and the healthcare team.
  • Manage members with chronic illnesses, co-morbidities, and/or disabilities to support cost-effective and efficient utilization of health benefits.
  • Obtain thorough and accurate member histories to develop individual care plans.
  • Establish short- and long-term goals in collaboration with members, caregivers, families, natural supports, and physicians.
  • Identify members who could benefit from an alternative level of care or other waiver programs.
  • Take overall responsibility for developing members' service care plans and ensuring access to those services.
  • Assist with implementing member care plans by facilitating service authorizations or referrals within the benefits structure or through permissible extra-contractual arrangements, as appropriate.
  • Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams to develop care management treatment plans.
  • Assist with problem-solving provider, claims, or service issues as needed.
  • Direct and oversee LPN/LVN, LSW, LCSW, LMSW, and other licensed non-RN professionals coordinating member services by assigning appropriate tasks, verifying and interpreting information they obtain, conducting additional assessments as needed, developing and monitoring care plans, and reviewing and providing regular input on their performance.
  • Travel to the worksite and other locations as necessary.

Desired Qualifications

  • An associate's degree, master's degree, or Master of Arts/Master of Science 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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