$3,000 sign-on bonus offered for this role!
/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 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 Supports) members in the Houston, Texas area. You must live in this area where you will be working from home or in the field, coming into the Houston office as needed. Training will be held in the office for the first 3-4 weeks. We also need associates in surrounding counties including Bay City, Lake Jackson, Galveston, Jasper, Conroe, Huntsville, El Campo.
As a Service Coordinator, you will be 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.
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 required.
Travel required within assigned territory.
Computer literate: MS Word, Outlook, Excel knowledge highly preferred.
Masters in Health/Nursing preferred.
Previous pediatric experience
Behavioral health experience
Previous managed care experience
Self Direction Experience strongly preferred.
/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 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./
Title: LTSS Service Coordinator RN Clinician (RN Field Nurse ) - Houston,Texas and surrounding areas 112969
Other Locations: TX-Beaumont
Requisition ID: 112969
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