LTSS Service Coordinator-RN Clinical Lead

2 weeks ago

Grand Prairie, Texas, United States Elevance Health Full time
LTSS Service Coordinator-RN Lead Clinician Job Description

Role Overview:

We are seeking an experienced LTSS Service Coordinator-RN Lead Clinician to join our team at Elevance Health. This role is responsible for leading a team and assisting management with day-to-day activities, such as workforce management and monitoring and prioritizing workflow.

Key Responsibilities:

  • Perform quality audits to ensure care plans are designed to optimize members' physical, behavioral, and social needs.
  • Assist in the development and maintenance of policies and procedures, training materials, and job resources.
  • Lead projects and participate in workgroups with cross-functional teams and serve as a representative on business unit/enterprise initiatives.
  • Perform process evaluations and tests and monitor systems/process enhancements.
  • Serve as the first line of contact for conflict resolution.
  • Participate in the Internal Appeal Process.
  • Responsible for overall management of members' cases within the scope of licensure; provide supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develop, monitor, evaluate, and revise the member's care plan to meet the member's needs, with the goal of optimizing member healthcare across the care continuum.
  • Responsible for performing 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.
  • Assist in problem-solving with providers, claims, or service issues. Serve as the first line of contact for conflict resolution.
  • 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 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.
  • Serve as a mentor or preceptor for new staff, assist in formal training, and may be involved in process improvement initiatives.
  • May also serve as lead to non-licensed LTSS Service Coordinators as applicable by state law and contract.

Requirements:

  • Requires an RN and a minimum of 5 years of clinical care experience and a minimum of 5 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. BA/BS in health-related field preferred.
  • May require state-specified certification based on state law and/or contract.

Elevance Health Values:

We are committed to creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes, and drive our shared success - for our consumers, our associates, our communities, and our business.

Benefits:

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.

Work Environment:

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

COVID-19 Vaccination Policy:

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.

 

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.

 

Accommodation Request:

Applicants who require accommodation to participate in the job application process may contact us for assistance.

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