LTSS Service Coordinator - RN

About This Role

This role involves managing a member's case within their scope of licensure, providing supervision to non-RN clinicians, and developing, monitoring, evaluating, and revising care plans to optimize member health across the care continuum.

Responsibilities

• Perform telephonic or face-to-face clinical assessments for identifying, evaluating, coordinating, and managing 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 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 individual care plan.
• Establish short and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians, and 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 utilization of services 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 treatment plans.
• Direct and/or supervise the work of LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals (non-RN) in coordinating services for the member.

Requirements

• Current, unrestricted RN license in applicable state(s)
• 3-4 years of experience in case management or similar role with individuals with chronic illnesses, co-morbidities, and/or disabilities

Qualifications

• 3-4 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.

Benefits