LTSS Service Coordinator – RN Clinician (RN Case Manager)

Elevance Health•Brunswick, OH

23h•Hybrid

About The Position

The MyCare Ohio health plan aims to deliver high-quality, trauma-informed, culturally competent, person-centered coordination for all members, addressing physical health, behavioral health, long-term services and supports, and psychosocial needs. The LTSS Service Coordinator-RN Clinician is responsible for the overall management of a member's case within the scope of licensure. This role involves developing, monitoring, evaluating, and revising the member's care plan to meet their needs, with a focus on person-centered thinking and optimizing member healthcare across the care continuum.

Requirements

High school diploma or GED equivalent
Minimum of 3 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.
Current, active valid and unrestricted RN license in Ohio state(s) required.

Nice To Haves

BA/BS in Health/Nursing preferred.
Strong preference for case management experience with older adults or individuals with disabilities.

Responsibilities

Perform telephonic and face-to-face functional 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.
Identify members for high risk complications and coordinate care in conjunction with the member and the health care team.
Manage members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
Obtain a 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, physicians; identify members that would benefit from an an alternative level of care or other waiver programs.
Develop the care plan for services for the member and ensure the member's access to those services.
Assist 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.
Interface with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management of person-centered care plans.
Assist in problem solving with providers, claims or service issues.