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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator

Case Management & AdvocacyUpdated on Nov 6
Full-timeWisconsin, USANo salary listed

About the Job

Requirements

  • A Bachelor of Arts or Bachelor of Science degree and at least two 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.

Responsibilities

  • Conduct face-to-face program assessments using tools with predefined questions to identify needs, and use motivational interviewing techniques for evaluations, coordination, and management of an individual's waiver and behavioral or physical health needs.
  • Use identification tools and processes to 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 utilization of long-term services and supports.
  • Document members' short- and long-term service and support goals, at their direction, in collaboration with their chosen care team, which may include caregivers, family, natural supports, service providers, and physicians.
  • Submit utilization and authorization requests to utilization management with documentation supporting and aligning with 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.
  • May mentor, serve as a subject matter expert or preceptor for new staff, assist in formal associate training, and participate in process improvement initiatives.

Desired Qualifications

  • A Bachelor of Arts or Bachelor of Science degree in a health care-related field.
  • 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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