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

Elevance Health•Jersey City, NJ

1d•$42 - $63•Hybrid

About The Position

The LTSS Service Coordinator - RN Clinician is responsible for overall management of a member’s case within the scope of RN licensure. The role provides direction and oversight to non-RN clinicians participating in the member’s case, consistent with applicable state law and contract requirements. It develops, monitors, evaluates, and revises member care plans to meet individual needs and optimize health care 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 service, and long-term services and supports needs. This 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 Hudson 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, 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, unrestricted RN license in applicable state(s).
May require state-specified certification based on state law and/or contract.

Nice To Haves

Associate, master’s, or other graduate degree in Health or Nursing.
Ability to travel to the worksite and other locations as necessary.

Responsibilities

Identify members at risk for 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 to develop an individual care plan.
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 service care plan and ensure access to those services.
Assist with implementing care plans by facilitating service authorizations or referrals within the benefit 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.
Provide direction and oversight to non-RN clinicians, including assigning tasks, verifying and interpreting information they obtain, conducting additional assessments as needed, revising care plans, and regularly reviewing and providing input on their performance.