These are field positions supporting our LTSS (Long Term Services and Support) members in Henry and Patrick Counties in Virginia. You will be working from home or in the field (mileage reimbursed) meeting with members where they live. Related computer equipment for a home office will be provided. You must have a high speed data connection.
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. Together we can drive the future of health care.
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 members 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 members needs.
- Minimum of 3years experienceworking with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or working with Medicaid, managed care and/or LTSS required.
- Current, unrestricted RN license in the state of Virginia is required.
- Experience in MS Office suite to include Word, Outlook and Excel.
- Travel within assigned territory in VA is required.
- Pediatric or Tech waiver experience is preferred.
- Case Management experiencepreferred.
- Home health experiencepreferred.