LTSS Svc Coord-RN Clinician

Elevance Health•Nashville, TN

14d•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 members’ needs and optimize their health care across the care continuum. The position 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 reasonable commuting distance of a posting location unless an accommodation is granted as required by law.

Requirements

High school diploma or GED equivalent and 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; equivalent combinations of education and experience are also accepted.
Current, active, valid, and unrestricted RN license in the required state(s).

Nice To Haves

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

Responsibilities

Perform telephonic and face-to-face functional assessments to identify, evaluate, coordinate, and manage members’ physical health, behavioral health, social services, and long-term services and supports needs.
Identify members at risk for 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 to develop individual care plans.
Establish short- and long-term goals in collaboration with members, caregivers, families, 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, assist with implementing care plans by facilitating service authorizations and referrals within the benefits structure or through permissible extra-contractual arrangements.
Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on person-centered care management plans.
Assist with problem solving related to providers, claims, or service issues.