Anthem, Inc. LTSS Svc Coord-RN Clinician in Houston, Texas
SHIFT: Day Job
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.
Locations - This position will cover the Alvin and Prairie Land areas of Texas, or close proximity to these areas. Must be able to travel within your assigned territory daily, and will work from home when not in the field. This position is supporting the nursing facility program of Amerigroup.
The LTSS Service Coordinator RN Clinician is responsible for overall management of member's case within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum serving members enrolled in the health plan; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Responsible for performing 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.
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 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 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.
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 Texas is required.
Day Travel required within assigned territory.
Computer literate: MS Word, Outlook, Excel, and Electronic Charting knowledge highly preferred.
Previous nursing facility experience preferred.
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.