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LTSS Service Coordinator-RN Cl...


Job Summary

Emporia, VA
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

LTSS Service Coordinator-RN Clinician, Central Virginia (PS4058)

About the 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.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. Together we can drive the future of health care.

This is a field position supporting our LTSS (Long Term Services and Support) members in the southern/central part of VA. You must live in an area noted below. You will be working from home or in the field (mileage reimbursed) meeting with members where they live. You must have the flexibility to come into the Richmond office for meetings a few times yearly. Related computer equipment for a home office will be provided. You must have a high speed data connection.


Powhatan/Amelia/Cumberland-Richmond area

Mecklenburg/Lawrenceville area

Prince George/Surry/Petersburg area

Northern Neck-Tappahannock area

Eastern Hanover/King William/Spotsylvania area-Ashland area

The LTSS Svc Coord RN Clinician is responsible for the overall management of members cases within the scope of licensure; you may provide direction to non-RN clinicians participating in the members case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the members care plan to meet the members needs, with the goal of optimizing member health care across the care continuum.

* As the RN Clinician you are responsible for performing face-to-face clinical assessments for the identification, evaluation, coordination and management of members' needs, including physical health, behavioral health, social services and long term services and supports. You would identify members for high risk complications and coordinates care in conjunction with the member and the health care team
* You manage members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits
* You would obtain thorough and accurate member history to develop individual care plans
* As the Nurse Clinician you collaborate with the members, caregivers, family, natural supports, physicians to establish short and long term goals; identifies members that would benefit from an alternative level of care or other waiver programs
* You, the RN Clinician will have overall responsibility to develop the care plan for services for the member and ensures the members access to those services.
* You might 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
* As the RN Clinician, you interface with Medical Directors, Physician Advisors and/or Inter-Disciplinary teams on the development of care management treatment plans
* You may also have the opportunity to assist in problem solving with providers, claims or service issues
* Additionally as the Nurse Clinician you may direct the work of other licensed professionals other than a Nurse, 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 members care plan to meet the members needs


You must live in VA and be an RN.

* You must have at least 2 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or working with Medicaid, managed care and/or LTSS
* You must have a current, unrestricted RN license in the state of Virginia
* You must be competent in MS Office suite to include Word, Outlook and Excel.

Preferred qualifications include:
* Masters degree
* Demonstrated ability to communicate with members who have complex medical needs and who may have communication barriers
* Clinical nursing experience with medically complex members dependent on life sustaining equipment
* Current or prior field/home health experience preferred.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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