Managed Care Coordinator
Location: Candidate must reside in Virginia, preferably within 50 miles of Richmond, Roanoke, or Tidewater region. While primarily remote, occasional travel to the office or to meet face to face with patients, members, and providers will be necessary.
The Managed Care Coordinator is responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract.
Primary duties may include, but are not limited to:
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's program needs.
Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support. The process does not involve clinical judgment.
Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.
Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
Identifies members that would benefit from expanded services.
Requires 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.
Specific education and years and type of experience may be required based upon state law and contract requirements.
BA/BS degree field of study in health care related field preferred.
Prior case management experience strongly preferred.
Prior experience working with individuals with behavioral health issues and/or developmental disabilities preferred.
Experience with community services board preferred.
Travels to worksite and other locations as necessary.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are 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.
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.
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.
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. Applicants who require accommodation to participate in the job application process may contact email@example.com assistance.