LTSS Service Coordinator - RN Clinician (RN Case Manager)

Elevance Health; Fayetteville (NC); Hybrid; USD 75,000 - 90,000; Full time

Benefits offered by this job

Paid time off

Health insurance

401(k) plan

Job summary

Elevance Health is seeking a Field LTSS Service Coordinator RN Clinician (RN Case Manager) in North Carolina. This field-based role covers Wake and Cumberland Counties with occasional in-office work and a hybrid policy.

You will assess, plan, implement, and monitor member care, coordinating with providers to optimize health outcomes across the care continuum. The role requires an RN with at least 3 years of experience working with chronic illnesses and complex needs.

Qualifications

• Requires RN license and minimum 3 years of experience working with individuals who have chronic illnesses, co-morbidities, or disabilities in a service coordination or case management role.
• Current, unrestricted RN license in applicable state(s) is required.
• State-specific certification may be required based on state law and/or contract.

Responsibilities

• Identifies high-risk members and coordinates care with the health care team.
• Manages members with chronic conditions to ensure cost-effective health benefits utilization.
• Obtains thorough member history to develop an individual care plan.
• Sets short- and long-term goals with the member and support network to identify needed services.
• Develops and ensures access to the member's care plan and services.
• Facilitates authorizations/referrals within benefits structure or extra-contractual arrangements.
• Interfaces with Medical Directors and care teams on treatment plan development.
• Assists in problem-solving with providers, claims, or service issues.
• Directs work of LPN/LVN and other licensed staff in coordinating services for the member.

Skills

Field-based work

Travel to client sites

Care coordination

Education

RN license

3 years chronic illness care/case management

Job description

LTSS Service Coordinator - RN Clinician (RN Case Manager)

Location:

This is a field position and the candidate should reside in Wake or Cumberland County, North Carolina.

Field

This field-based role in Wake County and Cumberland County, enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The LTSS Service Coordinator RN Clinician is responsible for overall management of 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 optimizing member health care across the care continuum. Responsible for performing 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.

How you will make an impact:

• 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.
• May also assist in problem solving with providers, claims or service issues.
• 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.

Minimum Requirements:

• Requires an RN and minimum of 3 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.
• May require state-specified certification based on state law and/or contract.

Preferred Skills, Knowledge, and Experience:

• MA/MS in Health/Nursing preferred.
• Travels to worksite and other locations as necessary.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health 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 should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.