LTSS Service Coordinator - RN Clinician (Middlesex County, NJ)

Elevance Health•Edison, NJ

1d•$42 - $63

About The Position

The LTSS Service Coordinator - RN Clinician is responsible for overall management of a member’s case within the scope of RN licensure. The position provides direction and oversight to non-RN clinicians participating in the member’s case, in accordance with applicable state law and contract. The RN develops, monitors, evaluates, and revises member care plans to meet needs and optimize health care across the care continuum. The role performs 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. This is a field-based role, primarily involving travel to client sites or other designated locations, with occasional office attendance for meetings or training. The candidate should reside in Middlesex County, New Jersey; alternate locations may be considered if within commuting distance of an office.

Requirements

High school diploma or 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; alternatively, an equivalent combination of education and experience.
Current, active, valid, and unrestricted RN license in applicable state(s).
May require state-specified certification based on state law and/or contract.

Nice To Haves

Associate, MA, or MS degree in Health or Nursing.

Responsibilities

Identify members at risk of high-risk complications and coordinate care with the member and health care team.
Manage members with chronic illnesses, co-morbidities, and/or disabilities to support 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 members, caregivers, family, natural supports, and physicians.
Identify members who may benefit from an alternative level of care or other waiver programs.
Develop the member’s care plan for services and ensure access to those services.
Assist with implementing member care plans by facilitating authorizations or referrals for services, as appropriate within the benefits structure or through permissible extra-contractual arrangements.
Interface 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 oversee LPN/LVN, LSW, LCSW, LMSW, and other licensed non-RN professionals coordinating member services, including assigning tasks, verifying and interpreting information they obtain, conducting additional assessments as needed, and reviewing and providing regular input on their performance.
Travel to the worksite and other locations as necessary.