LTSS Service Coordinator - RN Telehealth

Elevance Health•New York, NY

1d•$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 their RN licensure. This role involves providing supervision and direction to non-RN clinicians involved in the member's care, adhering to applicable state laws and contracts. 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 entire care continuum. This position offers a virtual, full-time work arrangement with flexibility, except for mandatory in-person training sessions. Candidates must reside in the tri-state area (NY, NJ, or CT), though alternate locations within commuting distance of an office may be considered. The role focuses on telephonic clinical assessments to identify, evaluate, coordinate, and manage member needs, including physical health, behavioral health, social services, and long-term services and supports. It involves identifying high-risk members, coordinating care with the member and healthcare team, managing chronic illnesses, co-morbidities, and disabilities for cost-effective utilization of benefits, and obtaining thorough member histories to develop individualized care plans. The RN establishes short and long-term goals with the member and their support system, identifies potential candidates for alternative levels of care or waiver programs, and ensures the member's access to services. The role may also involve facilitating authorizations/referrals, interfacing with Medical Directors and Inter-Disciplinary Teams, and assisting with provider or claims issues. A key responsibility is directing and supervising non-RN clinicians by assigning tasks, verifying information, conducting assessments, and reviewing performance.

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, or Cantonese 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 health care team.
Managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure 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, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.
Developing the care plan for services for the member and ensures the member's access to those services.
Facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.
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 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.