Managed Care Coordinator-RN Clinician

Elevance Health, Inc.; Miami (FL); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking an RN Clinician for Managed Care Coordination. This role focuses on coordinating and managing member care across health and social services, developing individualized care plans, and guiding non-RN clinicians under state regulations.

The position emphasizes telephonic and in-person assessments, high-risk identification, and care plan management designed to optimize health outcomes and cost-effective utilization of benefits, in a hybrid work setting.

Qualifications

• HS diploma or equivalent.
• Minimum 3 years of experience with chronic illnesses in case management or similar role.
• Current, active RN license in applicable state(s) required.

Responsibilities

• Perform telephonic or face-to-face clinical assessments to coordinate member care across physical health, behavioral health, social services and long-term supports.
• Identify high-risk members and coordinate care with the member and health care team.
• Manage members with chronic illnesses to ensure cost-effective and efficient utilization of health benefits.
• Obtain thorough member history to develop individualized care plans.
• Establish short and long-term goals with the member and caregivers; identify needs for alternative care or waivers.

Skills

Clinical assessments

Care coordination

Chronic illness management

Care planning

Interdisciplinary collaboration

Education

HS diploma or equivalent

RN license (Florida)

Job description

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

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 accommodation is granted as required by law.

Must be a resident of Florida

The Managed Care Coordinator - RN Clinician is responsible for overall management of members case within the scope of licensure. Provides supervision and direction to non-RN clinicians participating in the members case in accordance with applicable state law and contract. Develops, monitors, evaluates, and revises the members care plan to meet the members needs, with the goal of optimizing member health care across the care continuum.

How you'll make a difference:

• Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of members needs, including physical health, behavioral health, social services and long term services and supports.

• 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 members 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 members care plan to meet the members needs, and reviewing and providing input on the non-RN clinicians¿ performance on a regular basis.

Minimum 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, which would provide an equivalent background.

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

Preferred skills, qualifications and experience:

• HIV experience highly preferred

• Bilingual Spanish/English or Creole/English desired.

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

• Travels to worksite and other locations as necessary.

#LI

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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 (https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) 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 (https://info.flclearinghouse.com/) .