LTSS Svc Coord - RN Clinician

Remote

Contract (4 months 29 days)

Published 8 days ago

unrestricted RN license

NY Medicaid experience

LTSS

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.

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.

100% remote.

M‑F 8:30 - 5pm ET.

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

Min Pay Rate $26.06

Max Pay Rate $49.77

Currency USD

Unit hourly

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.

BCForward…