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Long-Term Services Support Coordinator
2 months ago
Position Title:
LTSS Service Coordinator - RN
Job Overview:
As a vital member of the healthcare team, the LTSS Service Coordinator - RN plays a crucial role in managing the care of members within the framework of their licensure. This position involves spending a significant amount of time in the field, engaging directly with patients, members, and healthcare providers.
Key Responsibilities:
- Oversee the comprehensive management of each member's case, ensuring compliance with the Texas Medicaid STAR+ PLUS program.
- Provide guidance and oversight to non-RN clinicians involved in the member's care, as necessary.
- Develop, assess, and adjust individual care plans to align with the specific needs of each member, aiming to enhance their overall health outcomes.
Impact on Member Care:
Conduct thorough clinical assessments, either via telephone or in-person, to identify and evaluate the diverse needs of members, which may encompass physical health, behavioral health, social services, and long-term support services. Recognize members at high risk for complications and coordinate their care in collaboration with the healthcare team.
Manage cases involving chronic conditions, co-morbidities, and disabilities to ensure efficient and cost-effective use of healthcare resources. Gather detailed member histories to formulate personalized care plans.
Work collaboratively with members, caregivers, and healthcare professionals to establish both short-term and long-term health goals, identifying opportunities for alternative care levels or waiver programs as appropriate.
The RN holds the primary responsibility for crafting the care plan and ensuring members have access to necessary services.
Assist in executing care plans by facilitating authorizations and referrals for service utilization, adhering to benefit structures and contractual agreements.
Engage with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams to develop effective care management strategies. Support problem-solving efforts related to provider interactions, claims, or service-related issues.
Qualifications:
Requires a current RN license and a minimum of three years of experience working with individuals facing chronic illnesses, co-morbidities, or disabilities in roles such as Service Coordinator or Case Manager. Equivalent combinations of education and experience will also be considered.
Bilingual proficiency in English and Spanish is preferred. State-specific certifications may be required based on local regulations.
Experience in managing care for older adults is highly desirable, along with a background in community or facility-based case management.
Work Environment:
This position operates within a hybrid workforce model, requiring in-person engagement at Elevance Health locations on a regular basis. Specific onsite requirements will be discussed during the hiring process.
Elevance Health prioritizes the health and safety of its associates and communities, necessitating COVID-19 vaccinations for candidates in certain roles.
Equal Opportunity Employer:
Elevance Health is committed to fostering a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to any protected status.
