LTSS Svc Coord - RN Clinician

Elevance Health; New York (NY); On-site; USD 35,900 - 68,563; Part time

Job summary

Elevance Health is seeking a registered nurse for a remote, contract-based care management role focused on LTSS for NY Medicaid members. You will oversee the member's care plan, coordinate telephonic or face-to-face assessments, and guide non‑RN clinicians under state law and contract to optimize health outcomes.

The role requires a HS diploma and 3+ years in chronic illness management, an active RN license, and LTSS/NY experience.

Qualifications

• HS diploma or equivalent with 3+ years in chronic illnesses, co-morbidities, and/or disabilities in a service coordination/case management role.
• Current, active, valid RN license in applicable state(s) required.
• MS in Health/Nursing preferred; state-specific certification may be required.

Responsibilities

• Oversee member care within licensure scope and develop/revise care plans to optimize health across the care continuum.
• Perform telephonic or in-person clinical assessments for evaluation, coordination, and management of needs.
• Identify high‑risk members and coordinate care with the health team; manage chronic conditions and cost-effective utilization.
• Interface with Medical Directors and other clinicians; supervise non‑RN clinicians in care coordination.

Skills

RN license

Care management

LTSS

NY Medicaid experience

Telephonic assessment

Education

HS diploma or equivalent

MS in Health/Nursing preferred

Job description

Remote

Contract (4 months 29 days)

Published 8 days ago

unrestricted RN license

NY Medicaid experience

LTSS

Primary duties may include, but are not limited to:

Responsible for overall management of member's case within the scope of licensure.

Provide direction and oversight to non‑RN clinicians participating in the member's case in accordance with applicable state law and contract; develop, monitor, evaluate, and revise 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 telephonic or 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.

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 insure 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, physicians; identify 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.

Interface 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.

Provide direction and oversight to 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.

Requirements

Requires a HS diploma or equivalent 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 that provides an equivalent background.

Current, active, valid and unrestricted RN license in applicable state(s) required.

MA/MS in Health/Nursing preferred.

May require state‑specified certification based on state law and/or contract.

Travels to worksite and other locations as necessary.

MUST have LTSS and NY experience.

Remote Work

100% remote.

M‑F 8:30 - 5pm ET.

Candidates must live within 50 miles of an Elevance Health PulsePoint.

Pay Rate Range

Min Pay Rate $26.06

Max Pay Rate $49.77

Currency USD

Unit hourly

Additional Pay Rate Notes

The pay range is the range BCForward in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer‑provided group life, voluntary life insurance, short‑term disability, long‑term disability, and 401k.

The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non‑standard compensation (e.g., benefits, paid time off, per diem, etc.).

EEO Statement

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

Legal Disclaimer

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at‑will regardless of the anticipated assignment duration.