LTSS Service Coordinator at Elevance Health

Nashville, Tennessee, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background
Specific education, years, and type of experience may be required based upon state law and contract requirements
Travels to worksite and other locations as necessary

Responsibilities

Conducting service coordination functions for a defined caseload of individuals in specialized programs
In collaboration with the person supported, facilitating the Person Centered Planning process, including conducting assessments, developing a comprehensive Person Centered Support Plan (PCSP) and backup plan
Interfacing with Medical Directors and participating in interdisciplinary care rounds to support development of a fully integrated care plan
Engaging the member’s circle of support and managing the individual’s physical health (PH)/behavioral health (BH)/LTSS needs, as required by applicable state law and contract, and federal requirements
Performing face-to-face program assessments using various tools with pre-defined questions for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver (such as LTSS/IDD), and BH or PH needs
Using tools and pre-defined identification process, identifying members with potential clinical health care needs (including potential for high-risk complications, addressing gaps in care) and coordinating those members’ cases as the single point of contact with the clinical healthcare management and interdisciplinary team
Managing non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of long-term services and supports
At the direction of the member, documenting their short- and long-term service and support goals in collaboration with the member’s chosen care team (caregivers, family, natural supports, service providers, physicians)
Identifying members that would benefit from an alternative level of service or other waiver programs
Serving as mentor, subject matter expert, or preceptor for new staff, assisting in formal training of associates, and participating in process improvement initiatives
Submitting utilization/authorization requests to utilization management with documentation supporting and aligning with the individual’s care plan
Reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement)
Assisting and participating in appeal or fair hearings, member grievances, appeals, and state audits

Skills

Service Coordination

Person Centered Planning

Motivational Interviewing

Case Management

Assessments

Care Coordination

LTSS

IDD

Behavioral Health

Physical Health

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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