Managed Care Coordinator-Clinician NonRN

Elevance Health•Newport News, VA

1d•Remote

About The Position

The Managed Care Coordinator-Clinician NonRN will be working under the direction/supervision of an RN, with overall responsibility for the member’s case, as required by applicable state law and contract, and will contribute to the care coordination process by performing activities within the scope of licensure. The role assists the responsible RN with telephonic or face-to-face assessments for the identification, evaluation, coordination and management of the member’s needs, including physical health, behavioral health, social services, and community services and supports.

Requirements

Requires an LPN/LVN, LSW, LCSW, or LMSW or license other than RN in accordance with applicable state law and Nursing Diploma or AS in Nursing or a related field and minimum of 2 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator or similar role; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted LPN/LVN, LSW, LCSW, LMSW or license other than RN (as allowed by state law) in applicable state(s) required.

Nice To Haves

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

Responsibilities

Assists responsible RN in identifying members for high risk complications.
Obtains clinical data as directed by the responsible RN.
Assists the responsible RN in identifying members that would benefit from an alternative level of care or other waiver programs.
Provides all information collected to the responsible RN, who verifies and interprets the information, conducts additional assessments, as necessary, and develops, monitors, evaluates, and revises the member’s care plan to meet the member’s needs.
Participates in coordinating care for members with chronic illnesses, co-morbidities, and/or disabilities as directed by responsible RN, and in conjunction with the RN, member and the health care team, to ensure cost effective and efficient utilization of health benefits.
Applies clinical guidelines and decision making skills based upon the current needs of the member, requiring an understanding of disease processes and terminology, but not requiring nursing judgment.