LTSS Service Coordinator-RN Clinician - PS32100

LTSS Service Coordinator-RN Clinician - PS32100Location: Midland, Texas, United StatesNewRequisition #: PS32100Your Talent. Our Vision . At Anthem, Inc ., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.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.This is a field nurse position supporting the STAR PLUS Nursing Facility Program in the LTSS (Long Term Services and Supports) dept. of the Texas Health Plan of Amerigroup located in Midland/Odessa, TX. You must live in or around the Midland/Odessa area. You will meet with members in nursing facilities in Ector County and surrounding areas. You will be working in the field and when not in the field you will work from home.The LTSS Service 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 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.

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. May direct the work of any 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 member’s needs, and reviewing and providing input on the non-RN clinicians performance on a regular basis.

Requires an RN; 3-4 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 the state of Texas required.

Masters in Health/Nursing preferred.

Knowledge of MFP (Money Follows the Person) program preferred.

Experience with MDS (Minimum Data Set) Document preferred.

Must have reliable vehicle with clean license and current ins. for local travel (mileage, parking, tolls reimbursed).

Computer skills: MS Word, Outlook, Excel

Experience working in the field (home health, nursing facility, MCO) preferred.

Knowledge of managed care, Medicaid, long term care preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at . EOE. M/F/Disability/Veteran .