LTSS Service Coordinator - RN Telehealth

Elevance Health•New York, NY

3d•$42 - $63•Remote

About The Position

The LTSS Service Coordinator - RN Telehealth is responsible for the overall management of a member's case within the scope of licensure. This role provides supervision and direction to non-RN clinicians participating in the member's case, adhering to applicable state law and contract. The primary goal is to develop, monitor, evaluate, and revise the member's care plan to meet their needs, ultimately optimizing their healthcare across the care continuum. This is a virtual role offering flexibility, with required in-person training sessions. Candidates must reside in the tri-state area (NY, NJ, or CT) or within a commuting distance from an office.

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 NY required.
Candidate must reside in the tri-state area (NY, NJ, or CT).

Nice To Haves

Bachelor's in Health/Nursing preferred.
Bilingual in Spanish, Mandarin, Arabic, or Korean highly preferred.
May require state-specified certification based on state law and/or contract.
CHHA and/or Medicare Experience Preferred.

Responsibilities

Performing telephonic clinical assessments for the identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports.
Identifying members for high-risk complications and coordinating care in conjunction with the member and the healthcare team.
Managing members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits.
Obtaining a thorough and accurate member history to develop an individual care plan.
Establishing short and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
Identifying members that would benefit from an alternative level of care or other waiver programs.
Developing the care plan for services for the member and ensuring the member's access to those services.
Facilitating authorizations/referrals for utilization of services, as appropriate, within the benefits structure or through extra-contractual arrangements.
Interfacing with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management treatment plans.
Assisting in problem-solving with providers, claims, or service issues.
Directing and/or supervising the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member.
Assigning appropriate tasks to non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments as necessary, and reviewing and providing input on non-RN clinicians' performance.