LTSS Svc Coord-RN Clinician

Elevance Health•Nashville, TN

13d•Hybrid

About The Position

The LTSS Service Coordinator – RN Clinician (Case Manager) manages members’ cases within the scope of RN licensure. The role develops, monitors, evaluates, and revises person-centered care plans to address member needs and optimize health care across the care continuum. It is open to candidates in Nashville and surrounding areas and follows a hybrid arrangement requiring in-office work 1–2 days per week. Candidates must live within a reasonable commuting distance unless a legally required accommodation is granted. The clinician conducts telephonic and face-to-face functional assessments; coordinates physical health, behavioral health, social services, and long-term services and supports; and works with members and their care teams to identify and address risks. The RN develops and oversees care plans, supports access to services, and may facilitate authorizations or referrals and help resolve provider, claims, or service issues. The anticipated end date listed for the posting is January 31, 2027.

Requirements

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

Nice To Haves

BA/BS in Health or Nursing.
Case management experience with older adults or individuals with disabilities is strongly preferred.

Responsibilities

Perform telephonic and face-to-face functional assessments to identify, evaluate, coordinate, and manage members’ physical health, behavioral health, social service, and long-term services and supports needs.
Identify members at risk of complications and coordinate care with members and their health care teams.
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 and develop individual care plans.
Establish short- and long-term goals in collaboration with members, caregivers, family, natural supports, and physicians.
Identify members who may benefit from an alternative level of care or other waiver programs.
Develop the care plan for member services and ensure members have 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 the development and management of person-centered care plans.
Assist with resolving provider, claims, or service issues.