Responsible for performing telephonic and face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs
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 ensure 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 of person-centered care plans
May also assist in problem solving with providers, claims or service issues.

Requires a high school diploma or GED equivalent
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
Current, active valid and unrestricted RN license in Ohio state(s) required.
BA/BS in Health/Nursing preferred.
Strong preference for case management experience with older adults or individuals with disabilities.

LTSS Service Coordinator – RN Clinician, RN Case Manager

Key skills