RN Clinician

4 weeks ago

Nashville, Tennessee, United States Elevance Health Full time
Job Summary:

The LTSS Service Coordinator - RN Clinician is responsible for the overall management of members' cases within the scope of licensure. This role involves providing supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract. The RN Clinician Service Coordinator develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member healthcare across the care continuum.

Key Responsibilities:
  • Perform telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of members' 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 healthcare 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.
  • 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 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 an RN and a 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, unrestricted RN license in applicable state(s) required.
Preferred Skills, Capabilities, and Experiences:
  • Proficiency in Microsoft Office (Excel, Word, Outlook, etc.) strongly preferred.
  • Case management experience strongly preferred.
  • Home health experience strongly preferred.
  • Medicaid experience strongly preferred.
  • Discharge planning experience strongly preferred.
  • 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.
Job Level:
Non-Management Non-Exempt Workshift: Job Family:
MED > Licensed Nurse

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