RN Case Manager (North Carolina) at Elevance Health in Cary, North Carolina

Job Description:

Location: Field associates spend 4-5 days per week in-person with patients, members or providers in the state of North Carolina.


The RN Case Manager (LTSS Service Coordinator- RN) is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.



How you will make an impact:

• 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.
  
  


• 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.
  
  


• 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.
  
  


• 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.
  
  


• Directs and/or supervises the work of any 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 an RN 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, which would provide an equivalent background.
  
  


• Current, 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 preferred.
  
  


• Travels to worksite and other locations as necessary preferred.
  
  


• Experience working with older adults in care management, provider or other capacity, highly preferred.
  
  


• Experience managing a community and/or facility-based care management case load, highly preferred.