LTSS Service Coordinator - RN Lead Clinician

Location: This is a field based position. Candidate would work remotely and travel to see members face to face about two to three times per week. Candidate would need to be based either in Miami-Dade or Hillsborough county.

The LTSS Service Coordinator - RN Lead Clinician is responsible for leading a team and assisting management with day to day activities, such as workforce management and monitoring and prioritizing workflow.

How You Will Make an Impact:

• Performs quality audits to ensure care plans designed optimize members physical, behavioral, and social needs.

• Assists in the development and maintenance of policies and procedures, training materials and job resources.

• Leads projects and participates in workgroups with cross functional teams and serves as a representative on business unit/enterprise initiatives.

• Performs process evaluations and tests and monitors systems/process enhancements.

• Serves as first line contact for conflict resolution.

• Participates in the Internal Appeal Process.

• Responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.

• Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long term services and supports.

• Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.

• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.

• Obtains a thorough and accurate member history to develop an individual care plan.

• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies 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.

• Assists in problem solving with providers, claims or service issues.

• Serves as the first line contact for conflict resolution.

• Directs and/or supervises 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.

• Serves as a mentor or preceptor for new staff, assists 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.

Minimum Requirements:

• Requires a High School diploma or equivalent and a minimum of 5 years clinical care experience and 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, active, valid and unrestricted RN license in applicable state(s) required.

Preferred Skills, Experiences, and Capabilities:

• BA/BS in health related field preferred.

• MA/MS in Health/Nursing preferred.

• Certification as a Managed Care Nurse (CMCN) preferred.

• May require state-specified certification based on state law and/or contract.

• 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 elevancehealthjobssupport@elevancehealth.com for assistance.