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

Elevance Health•Iselin, NJ

1d•$42 - $63•Onsite

About The Position

The LTSS Service Coordinator - RN Clinician manages members’ cases within the scope of RN licensure. The role provides direction and oversight to non-RN clinicians participating in a member’s case, consistent with applicable state law and contract requirements. The clinician develops, monitors, evaluates, and revises individualized care plans to address members’ needs and optimize their healthcare across the care continuum. The position performs telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage members’ physical health, behavioral health, social services, and long-term services and supports needs. It is field-based, with travel to client sites or other designated locations and occasional office attendance for meetings or training. The candidate should reside in Passaic 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, comorbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role, or an equivalent combination of education and experience.
Current, active, valid, unrestricted RN license in applicable state(s).
May require state-specified certification based on state law and/or contract.
Candidate should reside in Passaic County, New Jersey; alternate locations may be considered if within commuting distance of an office.
Ability to travel to worksite and other locations as necessary.

Nice To Haves

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

Responsibilities

Identify members at risk for complications and coordinate care with members and their healthcare teams.
Manage members with chronic illnesses, comorbidities, and/or disabilities to support cost-effective and efficient use of health benefits.
Obtain thorough and accurate member histories to develop individualized care plans.
Establish short- and long-term goals 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 service care plan and ensure access to services.
Facilitate service authorizations or referrals within the benefits structure or through permissible extra-contractual arrangements, as appropriate.
Collaborate 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 non-RN clinicians, including assigning tasks, verifying and interpreting member information they obtain, conducting additional assessments as needed, revising care plans, and regularly reviewing and providing input on their performance.
Conduct telephonic or face-to-face clinical assessments of members’ physical health, behavioral health, social services, and long-term services and supports needs.
Travel to client sites, worksite locations, and other locations as necessary.