Anthem, Inc. LTSS Service Coordinator-RN Clinician in Tullahoma, Tennessee
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.
This is a field position supporting our LTSS (Long Term Services and Support) members in Coffee County, TN and surrounding areas. When not in the field, you will be working from home (mileage reimbursed). You must have the flexibility to come into an Anthem office for meetings if needed. Related computer equipment for a home office will be provided. You must have a high-speed data connection The LTSS Service Coordinator – RN Clinician is responsible for the overall management and support coordination for individuals enrolled in the ECF Choices program. You will be responsible for, and may conduct, initial meetings with members referred for ECF CHOICES services, complete assessments to include gathering information to support eligibility and continued enrollment in the program, and will provide ongoing coordination of ECF CHOICES services and supports with a focus on supporting individuals to explore and obtain competitive integrated employment and maximize community integration. This role supports the member’s person centered support plan to meet their needs, with the goal of optimizing member healthcare and promotion and supporting integrated competitive employment and independent living as the first and preferred option for all individuals with I/DD.
Responsibilities include, but are not limited to the following:
Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, and coordination of the physical health, behavioral health, social services and long term services and supports needs of Individuals with Developmental Disabilities who are eligible to enroll in the Employment and Community First Choices Program (ECF.)
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.
Verifies and interprets information collected on members with I/DD, conducts additional assessments as necessary, and develops, monitors, evaluates, and revises the member’s individual care plan to meet the member’s needs.
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.
Assists the member in establishing short and long term goals through development of the person centered support plan and empowers members supported to fully engage in the process.
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.
Conducts, Health Risk Assessments (HRA’s) and assists individuals in the Middle Tennessee area with Dual Optimization and Coordination.
Current, unrestricted RN license in the state of Tennessee; 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.
Masters in Health/Nursing preferred.
Ability to work with multiple computer applications such as MS Word, Excel, electronic charging, and other computer applications.
Travel within assigned territory daily.
Experience working with Individuals with Developmental Disabilities.
Qualified Developmental Disabilities Professional (QDDP) or Qualified Intellectual Disabilities Professional (QIDP) or willing to become certified.
Previous Case Management, Health Coaching or Discharge Planning experience
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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.