Care Coordinator - Member Care & Program Coordination

Elevance Health; Waynesville (NC); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Elevance Health seeks a dedicated care coordinator to manage members' individual service plans in alignment with state laws and contracts. You will perform telephonic or in-person assessments to identify needs and coordinate care with clinical teams, ensuring cost-effective service utilization.

You will support non-clinical needs of members with chronic conditions and disabilities, set short- and long-term goals with the member and care network, and identify opportunities for expanded services

Qualifications

• Requires BA/BS degree and minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience which would provide an equivalent background.
• BA/BS degree field of study in health care related field preferred. Specific education and years and type of experience may be required based upon state law and contract requirements.
• Travels to worksite and other locations as necessary.
• For MMP, requires Community Health Worker certification to be obtained within one year of employment.

Responsibilities

• Responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract.
• Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's program needs.
• Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.
• The process does not involve clinical judgment.
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
• Identifies members that would benefit from expanded services.

Education

BA/BS degree in health care related field

Job description

Elevance Health seeks a dedicated care coordinator to manage members' individual service plans in alignment with state laws and contracts. You will perform telephonic or in-person assessments to identify needs and coordinate care with clinical teams, ensuring cost-effective service utilization.

You will support non-clinical needs of members with chronic conditions and disabilities, set short- and long-term goals with the member and care network, and identify opportunities for expanded services