Elevance Health
Overview
LTSS Service Coordinator - RN Clinician (RN Case Manager) - Elevance Health
LTSS Service Coordinator - RN Clinician is responsible for overall management of the member\'s case within the scope of licensure, developing, monitoring, evaluating, and revising the member\'s care plan to meet the member\'s needs, with the goal of prioritizing person-centered thinking and optimizing member health care across the care continuum. Location : This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as required, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Program context : Anthem/ Elevance Health is a managed care organization offering the Family Care Program in western/southwestern Wisconsin and Milwaukee County. Family Care is a Wisconsin long-term care program for older adults and adults with disabilities to maximize independent living, employment, and community contribution. Impact : The LTSS Service Coordinator-RN Clinician develops and manages care plans and coordinates services to meet member needs, prioritizing person-centered thinking and continuity of care. Responsibilities Responsible for performing telephonic and face-to-face functional assessments for identification, evaluation, coordination and management of member needs, including physical health, behavioral health, social services and long-term services and supports. Identifies members at high risk for complications and coordinates care with the member and the health care team. Manages members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan. Establishes short- and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians; identifies members who may benefit from alternative levels of care or other waiver programs. The RN has overall responsibility to develop the care plan for services for the member and ensures access to those services. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within the benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of person-centered care plans and may assist in problem solving with providers, claims or service issues. Minimum Requirements Requires an Associate of Science in Nursing or Bachelor of Science in Nursing and minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience providing an equivalent background. Current, active valid and unrestricted RN license in Wisconsin is required. Minimum of one year experience working with at least one of the Family Care target populations is required. Preferred Skills, Capabilities And Experiences BA/BS in Health/Nursing preferred. Strong preference for case management experience with older adults or individuals with disabilities. Long Term Care background preferred. Commitment to member-centered care and cultural responsiveness. Family Care/Partnership experience preferred. Comfortable using technology preferred. Strong interpersonal and communication skills. Ability to work collaboratively in a team environment. Problem solving and crisis management abilities. Travels to worksite and other locations including members\' home/community for in-person visits. Additional information Elevance Health only accepts resumes for compensation from agencies with a signed agreement. Unsolicited resumes submitted to hiring managers are the property of Elevance Health. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will be considered without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by applicable laws. Applicants who require accommodation may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered in accordance with all laws. Seniority level
Mid-Senior level Employment type
Full-time Job function
Management Industries
Business Consulting and Services Note: This description reflects the job information provided and does not introduce new facts.
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LTSS Service Coordinator - RN Clinician is responsible for overall management of the member\'s case within the scope of licensure, developing, monitoring, evaluating, and revising the member\'s care plan to meet the member\'s needs, with the goal of prioritizing person-centered thinking and optimizing member health care across the care continuum. Location : This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as required, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Program context : Anthem/ Elevance Health is a managed care organization offering the Family Care Program in western/southwestern Wisconsin and Milwaukee County. Family Care is a Wisconsin long-term care program for older adults and adults with disabilities to maximize independent living, employment, and community contribution. Impact : The LTSS Service Coordinator-RN Clinician develops and manages care plans and coordinates services to meet member needs, prioritizing person-centered thinking and continuity of care. Responsibilities Responsible for performing telephonic and face-to-face functional assessments for identification, evaluation, coordination and management of member needs, including physical health, behavioral health, social services and long-term services and supports. Identifies members at high risk for complications and coordinates care with the member and the health care team. Manages members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan. Establishes short- and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians; identifies members who may benefit from alternative levels of care or other waiver programs. The RN has overall responsibility to develop the care plan for services for the member and ensures access to those services. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within the benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of person-centered care plans and may assist in problem solving with providers, claims or service issues. Minimum Requirements Requires an Associate of Science in Nursing or Bachelor of Science in Nursing and minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience providing an equivalent background. Current, active valid and unrestricted RN license in Wisconsin is required. Minimum of one year experience working with at least one of the Family Care target populations is required. Preferred Skills, Capabilities And Experiences BA/BS in Health/Nursing preferred. Strong preference for case management experience with older adults or individuals with disabilities. Long Term Care background preferred. Commitment to member-centered care and cultural responsiveness. Family Care/Partnership experience preferred. Comfortable using technology preferred. Strong interpersonal and communication skills. Ability to work collaboratively in a team environment. Problem solving and crisis management abilities. Travels to worksite and other locations including members\' home/community for in-person visits. Additional information Elevance Health only accepts resumes for compensation from agencies with a signed agreement. Unsolicited resumes submitted to hiring managers are the property of Elevance Health. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will be considered without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by applicable laws. Applicants who require accommodation may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered in accordance with all laws. Seniority level
Mid-Senior level Employment type
Full-time Job function
Management Industries
Business Consulting and Services Note: This description reflects the job information provided and does not introduce new facts.
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