Managed Care Coordinator at Elevance Health

Fredericksburg, Virginia, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Managed CareIndustries

Requirements

BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community-based organizations (or any combination of education and experience providing an equivalent background)
Located in Spotsylvania or Fredericksburg, VA (or within reasonable commuting distance; candidates not meeting this will not be considered unless accommodation granted)
Travels to worksite and other locations as necessary
For MMP, requires Community Health Worker certification to be obtained within one year of employment

Responsibilities

Perform telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for identification, evaluation, coordination, and management of member's program needs
Using tools and pre-defined identification process, identify members with potential clinical health care needs (e.g., potential for high risk complications) and coordinate those members' cases with the clinical healthcare management and interdisciplinary team to provide care coordination support (process does not involve clinical judgment)
Manage non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of services
Establish short- and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians
Identify members that would benefit from expanded services
Overall management of member's individual service plan within the scope of position, as required by applicable state law and contract

Skills

Care Coordination

Needs Assessment

Case Management

Telephonic Assessment

Face-to-Face Assessment

Service Planning

Goal Setting

Chronic Illness Management

Interdisciplinary Coordination

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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