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Elevance Health

Sells health insurance and pharmacy benefits

LTSS Service Coordinator - Case Manager

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeOhio, 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 are required, or an equivalent combination of education and experience.
  • Strong preference for case management experience with older adults or individuals with disabilities.
  • A Bachelor of Arts or Bachelor of Science degree in Health or Nursing is preferred.

Responsibilities

  • Perform face-to-face program assessments using tools with predefined questions to identify needs, and apply motivational interviewing techniques for evaluation, coordination, and management of an individual's waiver and behavioral or physical health needs.
  • Use tools and predefined identification processes to identify members with potential clinical healthcare needs, including high-risk complications and gaps in care, and coordinate their cases as the single point of contact with clinical healthcare 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 their direction and in collaboration with their chosen care team, which may include caregivers, family, natural supports, service providers, and physicians.
  • Identify members who may benefit from an alternative level of service or other waiver programs.
  • May serve as a mentor, subject matter expert, or preceptor for new staff and assist with formal associate training; may participate in process-improvement initiatives.
  • 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, such as state and county agencies, Adult Protective Services, and law enforcement.
  • Assist with and participate in appeal or fair hearings, member grievances and appeals, and state audits.

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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