LTSS Service Coordinator – RN Clinician (RN Case Manager)

About the Role

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. The LTSS Service Coordinator-RN Clinician is responsible for overall management of a member's case within the scope of licensure, developing, monitoring, evaluating, and revising the member's care plan to meet their needs. The goal is to prioritize person-centered thinking and optimize member healthcare across the care continuum.

The MyCare Ohio health plan delivers high-quality, trauma-informed, culturally competent, person-centered coordination for all members, addressing physical health, behavioral health, long-term services and supports, and psychosocial needs.

Responsibilities

• Perform telephonic and face-to-face functional assessments to identify, evaluate, coordinate, and manage members' needs, including physical health, behavioral health, social services, and long-term services and supports.
• Identify members at high risk for complications and coordinate care in conjunction with the member and the healthcare 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 individualized care plan.
• Establish short- and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
• Identify members who 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 the implementation of member care plans by facilitating authorizations/referrals for service utilization, as appropriate, within benefits structure or through extra-contractual arrangements.
• Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management and person-centered care plans.
• Assist in problem-solving with providers, claims, or service issues.

Requirements

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

Preferred Qualifications

• BA/BS in Health/Nursing.
• Case management experience with older adults or individuals with disabilities.

Pay

The salary range for this position in Columbus, OH is $36.38/hr to $45.48/hr. The salary offered is based on several legitimate, non-discriminatory factors set by the company, including geographic location, work experience, education, and skill level.

Benefits

• Comprehensive benefits package (medical, dental, vision, short- and long-term disability).
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contribution with company match.
• Paid holidays and Paid Time Off (PTO).
• Life insurance.
• Wellness programs and financial education resources.

Schedule

This is a field-based role with associates primarily operating in the field, traveling to client sites or designated locations. Occasional office attendance is required for meetings or training. Elevance Health operates in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week, with specific requirements discussed during the hiring process.