LTSS Service Coordinator - RN Clinician (RN Case Manager)

Elevance Health•Raleigh, NC

10d•Onsite

About The Position

The LTSS Service Coordinator RN Clinician manages members’ cases within the scope of RN licensure. The role develops, monitors, evaluates, and revises member care plans to meet individual needs and optimize health care across the care continuum. It includes face-to-face clinical assessments to identify, evaluate, coordinate, and manage members’ physical health, behavioral health, social services, and long-term services and supports needs. This is a field-based position serving Wake and Cumberland Counties, North Carolina. The associate primarily travels to client sites or designated locations, with occasional office attendance for meetings or training. Candidates should reside in Wake or Cumberland County and be within a reasonable commuting distance of the posting location, unless an accommodation is granted as required by law. The position may involve travel to the worksite and other locations as necessary.

Requirements

Current, unrestricted RN license in applicable state(s).
At least 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 an equivalent combination of education and experience.
May require state-specified certification based on state law and/or contract.
Reside in Wake or Cumberland County, North Carolina, and be within reasonable commuting distance of the posting location unless an accommodation is granted.

Nice To Haves

MA/MS in Health or Nursing.

Responsibilities

Identify members at risk of complications and coordinate care with members and the health care team.
Manage members with chronic illnesses, co-morbidities, and/or disabilities to support cost-effective and efficient use of health benefits.
Obtain thorough and accurate member histories to develop individualized care plans.
Establish short- and long-term goals with members, caregivers, family, natural supports, and physicians; identify members who may benefit from an alternative level of care or other waiver programs.
Develop care plans for member services and ensure members’ access to those services.
As appropriate, facilitate authorizations and referrals for services within the benefits structure or through permissible extra-contractual arrangements.
Coordinate with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on care management treatment plans.
Assist with problem-solving provider, claims, or service issues.
Direct and/or supervise non-RN clinicians, including LPN/LVNs and social work professionals, by assigning tasks, verifying and interpreting information they obtain, conducting additional assessments as needed, and reviewing and providing input on their performance.