Managed Care Coordinator
Working Hours: Monday-Friday 8:00AM – 5:00PM
Location: WFH – BUT WITH SOME TRAVEL TO CLIENTS OR PATIENT 30%
Candidate should reside in the Tidewater area of the state. Specifically, within commuting distance to Hampton, Newport News, Norfolk, Chesapeake, Suffolk, Portsmouth, Franklin, Virginia Beach, Eastern Shore, Isle of Wright, Southampton, York.
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
The Managed Care Coordinator is responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination, and management of member program needs. Using tools and pre-defined identification process, identifies members with potential behavioral health care needs (including, but not limited to, potential for high-risk complications) and coordinates those members’ cases with the clinical healthcare management and interdisciplinary team and provides care coordination support. The process does not involve clinical judgment; this position manages non-clinical needs of members with behavioral health needs, chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of services. Establishes short- and long-term goals in collaboration with the members, caregivers, family, natural supports, and physicians. Identifies members that would benefit from expanded services.
How you will make an impact:
- Responsible for performing case management telephonically and/or by home visits within the scope of licensure for members with behavioral health and substance abuse or substance abuse disorder needs.
- Primary duties may include but are not limited to: Uses appropriate screening criteria knowledge and clinical judgment to assess member needs.
- Conducts assessments to identify individual needs and develops care plan to address objectives and goals as identified during assessment.
- Monitors and evaluates effectiveness of care plan and modifies plan as needed.
- Supports member access to appropriate quality and cost-effective care.
- Coordinates with internal and external resources to meet identified needs of the members and collaborates with providers.
- BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community-based organizations; or any combination of education and experience which would provide an equivalent background.
- BA/BS degree field of study in health care related field preferred. Specific education and years and type of experience may be required based upon state law and contract requirements.
- Experience in case management and telephonic and/or in person coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders preferred.
- QMHP certification or MA/MS in social work, counseling, or a related behavioral health field preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
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 – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.