RN Case Manager

Elevance Health - Gary, IN

Full-time - Mid Level

Gary, IN

Insurance Carriers and Related Activities

About the position

The RN Case Manager (LTSS Service Coordinator- RN) is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case, as required by the IN PathWays for Aging program; 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.

Responsibilities

• 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 ensure 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.
• Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member.

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.
• Current, 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.
• Experience working with older adults in care management, provider or other capacity, highly preferred.
• Experience managing a community and/or facility-based care management case load, highly preferred.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources