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LTSS Service Coordinator (Field RN)- North Houston TX PS14488 in Houston, TX at Anthem, Inc.

Date Posted: 12/5/2018

Job Snapshot

Job Description

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 nurse position supporting the STAR PLUS Nursing Facility Program in the LTSS (Long Term Services and Supports) dept. of the Texas Health Plan of Amerigroup. The candidate selected will have a home office and will work in the field the majority of the time and may on occasion be expected to come to the local office as directed by the Manager. When not driving (mileage, tolls reimbursed) in the field you will work from your home office using equipment supplied by the company. (laptop, IPad, printer, etc.). This position will cover North Houston TX.
The LTSS Service Coordinator RN Clinician is responsible for overall management of members case within the scope of licensure; provides supervision and 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 member’s needs, with the goal of optimizing member health care across the care continuum.
  • 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 members 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.
  • May direct the work of any 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 members 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; at least 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 the state of Texas required.
  • Knowledge of MNLOC form (Medical Necessity Level of Care) preferred.
  • Knowledge of MDS (Minimum Data Set) program preferred.
  • Travel within assigned territory required.
  • Computer skills: MS Word, Outlook, Excel; experience working with data bases and spreadsheet applications.
  • Experience using a laptop and iPad preferred.
  • Home health experience preferred.
  • Knowledge of managed care, Medicaid, Long Term Care preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.



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