Managed Care Coordinator-RN Clinician

Elevance Health•Miami, FL

2d•Remote

About The Position

The Managed Care Coordinator - RN Clinician is responsible for overall management of members’ cases within the scope of licensure. The RN provides supervision and direction to non-RN clinicians participating in a member’s case in accordance with applicable state law and contract. The role develops, monitors, evaluates, and revises members’ care plans to meet their needs and optimize health care across the care continuum. The position conducts telephonic or face-to-face clinical assessments and coordinates members’ physical health, behavioral health, social services, and long-term services and supports. It works with members, caregivers, families, natural supports, physicians, and the health care team to identify risks, establish goals, coordinate access to services, and support efficient use of health benefits. The role may facilitate service authorizations and referrals, collaborate with medical directors and interdisciplinary teams, address provider, claims, or service issues, and direct or supervise non-RN clinicians’ work. This role is primarily virtual full-time, with in-person training sessions required. Candidates must reside in Florida and be within reasonable commuting distance of the posting location unless an accommodation is granted. Travel to the worksite and other locations may be necessary.

Requirements

High school diploma or equivalent and at least 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or an equivalent combination of education and experience.
Current, active, valid, and unrestricted RN license in applicable state(s).
Must be a resident of Florida.
Must be within reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law.
May require state-specified certification based on state law and/or contract.
Travel to the worksite and other locations as necessary.

Nice To Haves

HIV experience highly preferred.
Bilingual Spanish/English or Creole/English desired.

Responsibilities

Perform telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage members’ physical health, behavioral health, social service, and long-term services and supports needs.
Identify members at risk of high-risk complications and coordinate care with the member and health care team.
Manage members with chronic illnesses, co-morbidities, and/or disabilities to support cost-effective and efficient utilization of health benefits.
Obtain thorough and accurate member histories to develop individual care plans.
Establish short- and long-term goals with members, caregivers, family, natural supports, and physicians.
Identify members who may benefit from an alternative level of care or other waiver programs.
Develop the member’s care plan and ensure access to the services included in it.
As appropriate, facilitate authorizations and referrals for services within the benefits structure or through permissible extra-contractual arrangements.
Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on care management treatment plans.
Assist with problem solving related to providers, claims, or service issues.
Direct and/or supervise non-RN clinicians coordinating member services, including assigning tasks, verifying and interpreting information they obtain, conducting additional assessments as needed, and reviewing and providing input on their performance.