LTSS Service Coordinator - RN Clinician (Madison County, IN & Randolph County, IN)

Elevance Health•Pendleton, IN

4d•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 their RN licensure. This role involves providing direction and oversight to non-RN clinicians involved in the member's care, in accordance with state law and contract requirements. The position entails developing, monitoring, evaluating, and revising the member's care plan to meet their needs, with the ultimate goal of optimizing their healthcare across the continuum of care. Responsibilities include conducting telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage member needs, encompassing physical health, behavioral health, social services, and long-term services and supports.

Requirements

HS diploma or equivalent.
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 applicable state(s) required.
May require state-specified certification based on state law and/or contract.

Nice To Haves

Associates/MA/MS in Health/Nursing preferred.
Travels to worksite and other locations as necessary.

Responsibilities

Identifies members at high risk for complications and coordinates care with the member and the healthcare team.
Manages members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits.
Obtains a thorough and accurate member history to develop an individual care plan.
Establishes short and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
Identifies members who would benefit from an alternative level of care or other waiver programs.
Develops the care plan for member services and ensures the member's access to those services.
May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within the benefits structure or through extra-contractual arrangements, as permissible.
Interfaces with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management treatment plans.
May also assist in problem-solving with providers, claims, or service issues.
Provides direction and oversight to LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by assigning appropriate tasks, verifying and interpreting member information, conducting additional assessments, and reviewing and providing input on performance.