Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it's a powerful combination. It's the foundation upon which we're creating greater access to 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.
Location: You must reside in Middle Tennessee. This is a \"Floater\" position that will require you to work in the field approximately 75% of the time. When not in the field, you will work from your home office. This role will cover counties throughout the state of Tennessee. (Mileage will be reimbursed according to current IRS guidelines.)
The LTSS Service Coordinator-RN Clinician for the Tennessee Health Plan is responsible for overall management of the member's case within the scope of licensure; may provide supervision or direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's person-centered support plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.
* The RN has overall responsibility to develop the person-centered support plan for services for the member and ensures the member's access to those services.
* Assists with the implementation of member care plans by facilitating authorizations / referrals for utilization of services, as appropriate, within benefits structure.
* Performs telephonic and 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.
* Visits members in their homes, nursing facilities, physician's offices, hospitals, and other provider facilities.
* 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 a person-centered support 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.
* Interfaces with members of the health care team on the development of person-centered support and care management treatment plans.
* May also assist in problem solving with providers, claims or service issues.
* May direct 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.
* Current, unrestricted RN license in the state of Tennessee; 2 or more years experience 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.
* Previous Case Management experience in Medicaid and / or Medicare preferred
* Proficiency in using computers and computer software packages required.
* Must be able to travel throughout assigned territory 75% of the time. (Mileage will be reimbursed according to current IRS guidelines.)
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 antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran.
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