LTSS Service Coordinator - RN Clinician

Elevance Health•Dallas, TX

3d•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 licensure. This role involves supervising and directing non-RN clinicians in accordance with applicable state law and contract. The primary goal is to develop, monitor, evaluate, and revise the member's care plan to meet their needs, aiming to optimize healthcare across the care continuum. This includes performing face-to-face clinical assessments to identify, evaluate, coordinate, and manage member needs related to physical health, behavioral health, social services, and long-term services and supports.

Requirements

Requires an RN and 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, unrestricted RN license in applicable state(s) required.
May require state-specified certification based on state law and/or contract.
Candidate should reside in Dallas, Collin, or Kaufman counties in Texas.
Must be open to travel up to 1 hour away daily.

Nice To Haves

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

Responsibilities

Identifies members for high risk complications and coordinates care in conjunction with the member and the health care 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 that would benefit from an alternative level of care or other waiver programs.
Develops the care plan for services for the member 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 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.
Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member's care plan to meet the member's needs, and reviewing and providing input on the non-RN clinicians' performance on a regular basis.