LTSS Service Coordinator – RN Clinician (RN Case Manager)

About the role

The MyCare Ohio health plan delivers high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The LTSS Service Coordinator‑RN Clinician is responsible for overall management of a member's case within the scope of licensure, develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of prioritizing person‑centered thinking and optimizing member health care across the care continuum.

This field‑based role enables associates to primarily operate in the field, traveling to client sites or designated locations as required, with occasional office attendance for meetings or training. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates must reside in Ohio; per hybrid/virtual work policy, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law.

Responsibilities

• Perform telephonic and face‑to‑face functional assessments for the identification, evaluation, coordination, and management of member needs, including physical health, behavioral health, social services, and long term services and supports.
• Identify members for high‑risk complications and coordinate care in conjunction with the member and the health care team.
• Manage members with chronic illnesses, co‑morbidities, and/or disabilities to ensure cost‑effective and efficient utilization of health benefits.
• Obtain a thorough and accurate member history to develop an individual care plan.
• Establish short‑ and long‑term goals in collaboration with the member, caregivers, family, natural supports, and physicians; identify members that would benefit from an alternative level of care or other waiver programs.
• Develop the care plan for services for the member and ensure the member's access to those services.
• Assist with 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 of person‑centered care plans.
• Assist in problem solving with providers, claims, or service issues.

Requirements

• High school diploma or GED equivalent and 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 providing an equivalent background.
• Current, active, valid, and unrestricted RN license in Ohio.

Qualifications

• BA/BS in Health/Nursing preferred.
• Strong preference for case management experience with older adults or individuals with disabilities.

Pay

For candidates working in person or virtually in Columbus, OH, the hourly salary range is $36.38/hr to $45.48/hr.

Benefits

Comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits subject to eligibility requirements).

Schedule

Field‑based position with primary work in the field traveling to client sites, occasional office attendance for meetings or training. Hybrid/virtual arrangements considered for candidates within commuting distance of an office. Must reside in Ohio.