Clinical Care Coordinator I

2 weeks ago


Nashville, Tennessee, United States Elevance Health Full time

Clinical Care Coordinator I

Location: Candidates must reside in the Middle Region of Tennessee, ideally within 50 miles of an Elevance Health PulsePoint location.

Hybrid/Virtual work environment.

Hours: Standard business hours, Monday through Friday.

The Clinical Care Coordinator I plays a crucial role in managing care for members with intricate and chronic health conditions. This involves assessing, developing, implementing, coordinating, monitoring, and evaluating care strategies aimed at enhancing member health outcomes throughout the healthcare continuum.

Key Responsibilities:

  • Engages in telephonic or on-site activities, including discharge planning in hospital settings.
  • Ensures that members have access to services that align with their health requirements.
  • Conducts thorough assessments to determine individual needs and formulates a tailored care management plan to achieve set objectives and goals.
  • Implements the care plan by facilitating necessary authorizations and referrals, adhering to the benefits structure or through additional arrangements as needed.
  • Coordinates both internal and external resources to fulfill identified needs effectively.
  • Monitors and assesses the effectiveness of the care management plan, making adjustments as required.
  • Collaborates with Medical Directors and Physician Advisors to develop comprehensive care management treatment plans.
  • Negotiates reimbursement rates when applicable.
  • Assists in resolving issues related to providers, claims, or services.

Minimum Qualifications:

  • A Bachelor’s degree in a health-related field, accompanied by a minimum of three years of clinical experience; or an equivalent combination of education and experience.
  • A current, unrestricted RN license in the relevant state(s) is mandatory.
  • Multi-state licensure is necessary for providing services across multiple states.

Preferred Skills and Experience:

  • Certification as a Case Manager is highly desirable.
  • Experience in Obstetrics is preferred.
  • Background in Hospital settings and/or Case Management is advantageous.


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