LTSS Service Coordinator-RN Clinician

Elevance Health•Nashville, TN

11d•Hybrid

About The Position

The LTSS Service Coordinator RN Clinician manages a member’s case within the scope of the RN’s licensure and provides supervision and direction to non-RN clinicians involved in the case, consistent with applicable state law and contract requirements. The role develops, monitors, evaluates, and revises member care plans to meet individual needs and optimize health care across the care continuum. The position performs face-to-face clinical assessments to identify, evaluate, coordinate, and manage members’ physical health, behavioral health, social service, and long-term services and supports needs. It is field-based, with travel to client sites or designated locations and occasional office attendance for meetings or training. Candidates must be located in Davidson and surrounding counties or within reasonable commuting distance of an office; alternate locations may be considered when within commuting distance.

Requirements

RN qualification and a current, unrestricted RN license in applicable state(s).
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.
May require state-specified certification based on state law and/or contract.
Must be located in Davidson and surrounding counties, or within reasonable commuting distance of an office, unless an accommodation is granted as required by law.
Travel to the worksite and other locations as necessary.

Nice To Haves

MA/MS in Health or Nursing preferred.

Responsibilities

Identify members at risk of complications and coordinate care with members and the health care team.
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, 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.
As appropriate, facilitate authorizations and referrals for services within the benefits structure or through permissible extra-contractual arrangements.
Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams to develop care management treatment plans.
Assist with problem-solving provider, claims, or service issues as needed.
Direct and/or supervise non-RN clinicians coordinating member services, including assigning tasks, verifying and interpreting member information, conducting additional assessments as needed, revising care plans, and reviewing and providing input on clinician performance.