Anthem, Inc. LTSS Service Coordinator-RN Clinician in Abilene, Texas
SHIFT: Day Job
Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
This is a field based position and the territory for this position is Abilene, TX and surrounding areas or Monahans, Pecos, Odessa and the surrounding areas.
The LTSS Service Coordinator-RN Clinician is responsible for overall management of members case within the scope of licensure; you may provide direction to non-RN clinicians participating in the members case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the members care plan to meet the member’s needs, with the goal of optimizing member health care across the care continuum.
Primary duties include but not limited to:
Responsible for performing 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 coordinates care in conjunction with the member and the health care team.
Manage members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
Obtain thorough and accurate member history to develop individual care plans.
Collaborate with the members, caregivers, family, natural supports, physicians to establish short and long term goals; identifies members that would benefit from an alternative level of care or other waiver programs.
Develop the care plan for services for the member and ensures the members access to those services.
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.
Interface 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.
Direct the work of other licensed professionals other than a Nurse, 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 members care plan to meet the member’s needs
The health and safety of our associates, members and communities is a top priority for Anthem. This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic. Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, our communities, our families and ourselves. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace, vaccination is required for this role. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson).
If you do not meet the requirements for this position, we encourage you to review other positions that currently allow virtual work. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis. Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com
Current, unrestricted RN license in the state of Texas is required.
Minimum of 3 years of clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role is required.
Experience using a computer including Microsoft Office Word, Outlook and Excel preferred.
Experience working in Pediatrics is strongly preferred.
Home Health experience is preferred.
Case Management experience is preferred.
Medicaid and/or Managed Care experience is preferred.
Experience working with members/patients in long-term care is preferred.
Bilingual English-Spanish preferred
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.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.