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Anthem, Inc. LTSS Service Coordinator-RN Clinician in Poquoson, Virginia

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc. it’s a powerful combination, and 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

This is a field position supporting our LTSS (Long Term Services and Support) members in Isle of Wright, VA area. When not in the field, you will be working from home (mileage reimbursed). You must have the flexibility to come into an Anthem office for meetings if needed. Related computer equipment for a home office will be provided. You must have a high speed data connection.

The LTSS Service Coordinator-RN Clinician is responsible for overall management of member's case enrolled in the Commonwealth Coordinated Care Plus (CCC Plus) program 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 such as EDCD, Technology, or ID/DD Waivers.

  • 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.

  • May also assist in problem solving with providers, claims or service issues.

  • May direct 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.

Qualifications

  • Requires an RN; a minimum of 3 years of experience 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 Virginia is required.

  • Masters in Health/Nursing preferred.

  • Bi-lingual Spanish a preferred.

  • Waivers experience preferred.

  • Local travel required (mileage reimbursed).

  • Knowledge of long term care, Medicaid, managed care preferred.

  • Pediatric experience preferred.

  • Field experience (home health, etc.) preferred.

  • Computer skills: MS Office (Word, Outlook, Excel) Facets, Care Compass a plus. You must be comfortable working on a computer. You will be working on multiple screens, utilizing web-based applications and updating excel spreadsheets.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran

REQNUMBER: PS41664

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