Anthem, Inc. LTSS Service Coordinator-Auditor in Miami, Florida
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.
The LTSS Svc Coord-Auditor is responsible for auditing member individual service plans within the scope of position, as required by applicable state law and contract. The audit process does not involve clinical judgment.
Primary duties may include, but are not limited to:
Audits program needs assessments and member’s long term service and support needs to ensure that established service plans are appropriate.
Audits to determine whether members with potential clinical health care needs (including, but not limited to, potential for high risk complications) are coordinated with the clinical healthcare management and interdisciplinary team.
Audits to determine whether the non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, are being met to insure cost effective and efficient utilization of long term services and supports.
Audits the short and long term service and support goals that were established for the member and ensures the level of service and/or waiver programs are appropriate.
Documents audit findings, identifies issues and informs management. Assesses and identifies training opportunities for the staff.
Auditors shall meet one of the following qualifications:
Auditors with the following qualifications shall also have a minimum of two
years of relevant experience: (a)Bachelor’s degree in social work, sociology, psychology, gerontology, or a related social services field; (b)Registered nurse, licensed to practice in the State; (c)Bachelor’s degree in a field other than social science; or
Auditors with a master’s degree in social work, sociology, psychology, gerontology, or a related social services field may substitute experience obtained through a practicum, internship, or clinical rotation on an equivalent basis for up to one (1) year of the experience requirements.
(a)Auditors with the following qualifications shall also have a minimum of four (4) years of relevant experience: Licensed Practical Nurse, licensed to practice in the State. Auditors without the aforementioned qualifications may substitute professional human service experience on a year-for-year basis for the educational requirement. Case Managers without a bachelor’s degree shall have a minimum of six (6) years of relevant experience. All Auditors are required to obtain a successful Level II criminal history screening and/or background investigation.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.