Anthem, Inc RN LTSS Service Coordinator (Remote) TEXAS: La Pryor, Pearsall, Dilley, Uvalde, Crystal City, Carrizo Springs, Cotulla and surrounding areas in Houston, Texas
RN LTSS Service Coordinator (Remote) TEXAS: La Pryor, Pearsall, Dilley, Uvalde, Crystal City, Carrizo Springs, Cotulla and surrounding areas
Location: Texas, United States
Requisition #: PS23151
Post Date: 6 hours ago
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company. Together we can drive the future of health care.
Location: LaPryor, Pearsall, Dilley, Uvalde, Crystal City, Carrizo Springs, Cotulla and surrounding areas.
This position supports our STAR Kids members in. You will train for approximately 4 weeks in our Lubbock or Grand Prairie office (hotel provided) and then the position will become remote from your home. You will be given the equipment needed for a home office. This is a field position; travel throughout the service area, visiting our members, is required (mileage reimbursed). Residency in this general area is required.
Responsible for overall management of members case within the scope of licensure; you may provide direction to nonRN 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.
Primary duties include but not limited to:
Responsible for performing 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.
Identify members for high risk complications and coordinates 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 thorough and accurate member history to develop individual care plans.
Collaborate with the members, caregivers, family, natural supports, physicians to establish short and long term goals; identifies members that would benefit from an alternative level of care or other waiver programs.
Develop the care plan for services for the member and ensures the members access to those services.
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.
Assist in problem solving with providers, claims or service issues.
Direct the work of other licensed professionals other than a Nurse, 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.
Current, unrestricted RN license in the state of Texas is required.
Minimum of 3 years of clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role is required.
Experience working in Pediatrics is strongly preferred.
Home Health experience is preferred.
Case Management experience is preferred.
Medicaid and/or Managed Care experience is preferred.
Experience working with members/patients in long-term care is preferred.
Bilingual English-Spanish is very helpful.
As this position requires field work, reliable transportation is required.
Good knowledge of Microsoft office products is required, along with the ability to use a laptop computer.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.