LTSS Service Coordinator - RN Clinician (Marion County)

Elevance Health•Indianapolis, IN

1d•Hybrid

About The Position

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 healthcare across the care continuum. This is a field-based role requiring travel to client sites or designated locations, with occasional office attendance. Candidates must reside in Marion County or within a commuting distance to an office. The role involves telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage member needs, including physical health, behavioral health, social services, and long-term services and supports. The clinician identifies high-risk members, coordinates care with the member and healthcare team, and manages members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits. Responsibilities include obtaining member history, developing individual care plans with short and long-term goals in collaboration with the member, caregivers, family, and physicians, and identifying members who would benefit from alternative levels of care or waiver programs. The RN is responsible for developing and ensuring access to the member's care plan services, potentially facilitating authorizations and referrals. The role involves interfacing with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams, and may assist in problem-solving with providers, claims, or service issues. Additionally, the RN provides direction and oversight to LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals (other than RN) in coordinating services, including assigning tasks, verifying information, conducting assessments, and reviewing performance.

Requirements

Requires a high school diploma or GED equivalent and a 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 Indiana state required.

Nice To Haves

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

Responsibilities

Performing telephonic or face-to-face clinical 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.
Identifying members for high risk complications and coordinates care in conjunction with the member and the health care team.
Managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
Obtaining a thorough and accurate member history to develop an individual care plan.
Establishing short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.
Developing the care plan for services for the member and ensures the member's access to those services.
Facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.
Interfacing with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans.
Assisting in problem solving with providers, claims or service issues.
Providing direction and oversight to LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member's care plan to meet the member's needs, and reviewing and providing input on the non-RN clinicians' performance on a regular basis.