LTSS Svc Coord-RN Clinician (US)

Elevance Health•Topeka, KS

2d•Remote

About The Position

The LTSS Svc Coordinator- RN Clinician is responsible for overall management of member's case within the scope of licensure. Provide direction and oversight to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. How you will make an impact: Responsible for performing telephonic or face-to-face 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. Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team. Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan. Establishes 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. The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans. May also assist in problem solving with providers, claims or service issues. Provide direction and oversight to 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.

Requirements

Requires a HS diploma or equivalent 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, active valid and unrestricted RN license in applicable state(s) required.

Nice To Haves

MA/MS in Health/Nursing preferred.
May require state-specified certification based on state law and/or contract.
Travels to worksite and other locations as necessary.

Responsibilities

Performing telephonic or face-to-face 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 coordinates 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.
Providing direction and oversight to LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member.
Assigning appropriate tasks to the non-RN clinicians.
Verifying and interpreting member information obtained by non-RN clinicians.
Conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member's care plan to meet the member's needs.
Reviewing and providing input on the non-RN clinicians' performance on a regular basis.