LTSS Service Coordinator - RN at Elevance Health

Nashville, Tennessee, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

RN license; current, unrestricted RN license in applicable state(s) required
3-4 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 which would provide an equivalent background
Ability to travel to worksite and other locations as necessary (field-based role in Knox, Anderson, Claiborne, Williamson, Davidson, Montgomery, Shelby, Tipton, or Fayette Counties in Tennessee; candidates not within reasonable commuting distance not considered unless accommodation granted)

Responsibilities

Overall management of member's case within the scope of licensure
Provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract
Develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum
Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports
Identifies members for high-risk complications and coordinates care in conjunction 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 that would benefit from an alternative level of care or other waiver programs
Develops the care plan for services for the member and ensures the member's access to those services
Assists with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible
Interfaces with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management treatment plans
Assists in problem-solving with providers, claims, or service issues
Directs and/or supervises the work of LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, by assigning appropriate tasks, verifying and interpreting member information, conducting additional assessments as necessary, developing/monitoring/evaluating/revising care plans, and reviewing/providing input on their performance

Skills

Case Management

Care Coordination

Clinical Assessment

Care Planning

Chronic Disease Management

Behavioral Health

LTSS

Telephonic Assessment

Face-to-Face 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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