LTSS Service Coordinator - RN Clinician (RN Case Manager) at Elevance Health

Waukesha, Wisconsin, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

High school diploma or GED equivalent and 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)

Responsibilities

Perform telephonic and face-to-face functional 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 at high risk for 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 an individual care plan
Establish short- and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians; identify members who 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 member care plans by facilitating authorizations/referrals for services within benefits structure or through extra-contractual arrangements
Interface with Medical Directors, Physician Advisors, and/or Interdisciplinary Teams on development of person-centered care plans; assist in problem-solving with providers, claims, or service issues
Overall management of member's case within scope of licensure, including developing, monitoring, evaluating, and revising the care plan to meet needs and optimize health care across the continuum, prioritizing person-centered thinking

Skills

Case Management

Care Coordination

Functional Assessment

Care Planning

Chronic Illness Management

LTSS

Behavioral Health

Social Services

Telephonic Assessment

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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