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

Elevance Health•Iselin, NJ

1d•Onsite

About The Position

The LTSS Service Coordinator - RN Clinician manages members’ cases within the scope of RN licensure and provides direction and oversight to non-RN clinicians involved in each case, in accordance with applicable state law and contract requirements. The role develops, monitors, evaluates, and revises member care plans to address individual needs and optimize health care across the care continuum. The position performs telephonic and 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 a field-based role involving travel to client sites or designated locations, with occasional office attendance for meetings or training. The candidate should reside in Passaic County, New Jersey; alternate locations may be considered when within commuting distance of an office.

Requirements

High school diploma or equivalent.
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.
Current, active, valid, and unrestricted RN license in the applicable state(s).
May require state-specified certification based on state law and/or contract.

Nice To Haves

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

Responsibilities

Identify members at risk of 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 a thorough and accurate member history and develop an individual care plan.
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 the care plan for member services and ensure members have access to those services.
Assist with implementing care plans by facilitating service authorizations or referrals, as appropriate within the benefits structure or through permissible extra-contractual arrangements.
Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on care management treatment plans.
Assist in resolving provider, claims, or service issues.
Direct and oversee LPN/LVN, LSW, LCSW, LMSW, and other licensed non-RN professionals coordinating member services.
Assign appropriate tasks to non-RN clinicians, verify and interpret information they obtain, conduct additional assessments as needed, and develop, monitor, evaluate, and revise member care plans.
Review and provide regular input on non-RN clinicians’ performance.
Travel to worksites and other locations as necessary.