Managed Care Coordinator - Southwest Virginia at Elevance Health

Roanoke, Virginia, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Healthcare, Managed CareIndustries

Requirements

Reside in Wytheville or areas south of Wytheville
Hold a QHMP certification in Virginia
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 equivalent combination of education and experience)
BA/BS degree in a health care related field preferred
Specific education, years, and type of experience may be required based upon state law and contract requirements
Within reasonable commuting distance from posting location(s) unless accommodation granted
Ability to travel to worksite and other locations as necessary

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
Use tools and pre-defined identification process to identify members with potential clinical health care needs (including 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

Skills

Key technologies and capabilities for this role

QHMP certificationcare coordinationneeds assessmentcase managementhealthcare managementtelephonic assessmentgoal setting

Questions & Answers

Common questions about this position

Is this a remote position?

This is a virtual full-time role providing maximum flexibility and autonomy, except for required in-person training sessions when indicated. Candidates must reside within a reasonable commuting distance from the posting location(s), specifically Wytheville or areas south of Wytheville.

What are the education and experience requirements for this role?

A 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 are required. A degree in a health care related field is preferred, and the candidate must hold a QHMP certification in Virginia.

What is the salary for this Managed Care Coordinator position?

This information is not specified in the job description.

What are the main responsibilities of the Managed Care Coordinator?

The role involves performing telephonic or face-to-face history and program needs assessments, identifying members with potential clinical health care needs and coordinating their cases, managing non-clinical needs for members with chronic illnesses, and establishing short and long-term goals with members and their support networks.

What makes a strong candidate for this position?

Strong candidates will have a BA/BS in a health care related field, at least 1 year of direct experience with the program population or community-based organizations, reside in Wytheville or areas south with QHMP certification in Virginia, and be prepared for some travel to worksites.

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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