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Care Management Coordinator
2 months ago
Location: Candidates should reside within a reasonable commuting distance of an Elevance Health office.
Shift: Standard work hours are Monday through Friday, with occasional weekend duties; schedule flexibility is expected.
The Managed Care Coordinator - RN plays a pivotal role in overseeing the comprehensive management of member cases within their licensure scope. This position involves guiding and supervising non-RN clinicians engaged in member care, ensuring compliance with state regulations and contractual obligations. The coordinator is tasked with developing, monitoring, assessing, and updating care plans tailored to meet individual member needs, aiming to enhance overall health outcomes across the healthcare spectrum.
Key Responsibilities:
- Conduct telephonic or in-person clinical evaluations to identify, assess, coordinate, and manage the diverse needs of members, encompassing physical health, behavioral health, social services, and long-term support.
- Recognize members at high risk for complications and collaborate with healthcare teams to coordinate effective care.
- Oversee the management of members with chronic conditions, co-morbidities, and disabilities to ensure efficient and cost-effective use of health benefits.
- Gather comprehensive member histories to formulate personalized care plans.
- Establish both short-term and long-term objectives in partnership with members, their families, and healthcare providers; identify members who may benefit from alternative care levels or waiver programs.
- Assume overall responsibility for developing care plans and ensuring members have access to necessary services.
- Facilitate the implementation of care plans by managing authorizations and referrals for service utilization, adhering to benefit structures and contractual agreements.
- Collaborate with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams to formulate care management strategies.
- Assist in resolving issues related to providers, claims, or service delivery.
- Supervise and direct the activities of LPNs, LSWs, LCSWs, LMSWs, and other licensed professionals in coordinating member services, ensuring appropriate task delegation and performance evaluation.
Minimum Qualifications:
- Current RN license and a minimum of three years of experience in managing individuals with chronic illnesses, co-morbidities, or disabilities in roles such as Service Coordinator or Case Manager.
Preferred Qualifications:
- Master's degree in Health or Nursing.
- State-specific certifications may be required based on local regulations.
Company Overview: Elevance Health is committed to enhancing lives and communities by simplifying healthcare. As a leading organization in the healthcare sector, we seek individuals who are dedicated to making a positive impact on our members and the communities we serve.
Work Environment: Elevance Health fosters a culture that promotes both strategic advancement and personal growth for our associates. Our core values and behaviors are integral to our success and the success of our members and communities.
Benefits: We offer a competitive range of rewards, including merit increases, paid time off, medical, dental, and vision benefits, as well as retirement plans and wellness programs.
Equal Opportunity Employer: Elevance Health is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to various protected statuses.
