Description
SHIFT: Day Job
SCHEDULE: Full-time
Virginia
LTSS Service Coordinator-RN Lead Clinician
Remote with some Travel.
Be part of an extraordinary teamWe are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high performance culture that empowers you to make an impact?
The use of this job is limited to large LTSS programs within the GBD Medicaid business unit. If you believe this to be the best match for your position, please consult with your Human Resources partner prior to using this job (HRBP should work with Compensation).
Responsible for leading a team and assisting management with day to day activities, such as workforce management and monitoring and prioritizing workflow.
Performs quality audits to ensure care plans designed optimize member's 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.
Qualifications
Requirments:
Requires an RN and 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, unrestricted RN license in applicable state(s) required.
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.
Travel required.
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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem 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 ability@icareerhelp.com for assistance.
REQNUMBER: PS70967
