Elevance Health - Greencastle, IN
posted 13 days ago
Full-time - Mid Level
Greencastle, 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. Field associates spend 4-5 days per week in-person with patients, members or providers.
Responsibilities
- Perform 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.
- Identify members for high risk complications and coordinate care in conjunction with the member and the health care team.
- Manage members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of health benefits.
- Obtain a thorough and accurate member history to develop an individual care plan.
- Establish short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identify members that would benefit from an alternative level of care or other waiver programs.
- Develop the care plan for services for the member and ensure the member's access to those services.
- 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.
- Interface with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans.
- Assist in problem solving with providers, claims or service issues.
- Direct and/or supervise 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 benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
