Pleasanton at Elevance Health

Kansas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

HS diploma or equivalent
Minimum of 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role (or equivalent combination of education and experience)
Current, active, valid, and unrestricted RN license in applicable state(s)
Reside in Linn, Coffey, or Anderson County in Kansas (or within reasonable commuting distance from posting locations)

Responsibilities

Perform telephonic or face-to-face clinical assessments for identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports
Identify members for high-risk complications and coordinate care with the member and health care team
Manage members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits
Obtain thorough and accurate member history to develop individual care plans, establishing short- and long-term goals in collaboration with member, caregivers, family, natural supports, and physicians
Identify members that would benefit from alternative levels of care or waiver programs
Develop the care plan for services and ensure member's access to those services
Assist with implementation of care plans by facilitating authorizations/referrals for services within benefits structure or extra-contractual arrangements
Interface with Medical Directors, Physician Advisors, and/or Interdisciplinary Teams on development of care management treatment plans
Assist in problem-solving with providers, claims, or service issues
Provide direction and oversight to non-RN clinicians (e.g., LPN/LVN, LSW, LCSW, LMSW), including assigning tasks, verifying/interpreting member information, conducting additional assessments, developing/monitoring/evaluating/revising care plans, and reviewing performance
Overall management of member's case within scope of RN licensure, including developing, monitoring, evaluating, and revising care plans to optimize health care across the care continuum

Skills

Key technologies and capabilities for this role

RNCase ManagementClinical AssessmentCare Plan DevelopmentTelephonic AssessmentFace-to-Face AssessmentChronic Illness ManagementBehavioral HealthLong Term Services and SupportsLTSS

Questions & Answers

Common questions about this position

What is the location requirement for this position?

Candidates must reside in Linn, Coffey, or Anderson County in Kansas, and those not within a reasonable commuting distance from the posting locations will not be considered unless an accommodation is granted.

Is this a remote or field-based role?

This is a field-based role where associates primarily operate in the field, traveling to client sites or designated locations, with occasional office attendance for meetings or training.

What are the main responsibilities of the RN Case Manager?

The RN Case Manager manages the member's case, performs telephonic or face-to-face clinical assessments, develops and revises care plans, coordinates care with health teams, and provides oversight to non-RN clinicians.

What qualifications are needed for this RN Clinician role?

The role requires an active RN license, as it involves case management within the scope of licensure, clinical assessments, care plan development, and oversight of non-RN clinicians like LPN/LVN, LSW, LCSW, and LMSW.

What makes a strong candidate for this LTSS Service Coordinator position?

Strong candidates reside in the required Kansas counties (Linn, Coffey, or Anderson), hold an active RN license, and have experience in case management, clinical assessments, care coordination for chronic illnesses, and overseeing non-RN clinicians.

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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