LTSS Service Coordinator - RN Telehealth

Elevance Health•Brooklyn, NY

4d•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 focus is on developing, monitoring, evaluating, and revising the member's care plan to meet their individual needs, with the ultimate goal of optimizing their healthcare across the entire care continuum. This position is primarily virtual, offering flexibility, but requires in-person training sessions. Candidates must reside in the tri-state area (NY, NJ, or CT), with alternate locations considered if within commuting distance of 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, 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 identification, evaluation, coordination, and management of member needs, including physical health, behavioral health, social services, and long-term services and supports.
Identifying members at high risk for 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, and natural supports.
Identifying members who would benefit from an alternative level of care or other waiver programs.
Developing the care plan for member services 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.