- Responsible for performing telephonic and/or virtual outreach to individuals in specialized programs, providers, or other key stakeholders involved in any transitions of care of members, to support the efficacy of the care plan and/or to align with contractual requirements for member outreach, such as coordination and management of an individual's waiver (such as LTSS/IDD), behavioral health or physical health needs.
- Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.
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- At the direction of the member, documents their short- and long-term service and support goals in collaboration with the member's chosen care team that may include, caregivers, family, natural supports, and physicians. Identifies members that would benefit from an alternative level of service or other waiver programs.
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- Assists and participates in appeal or fair hearings, member grievances, appeals and state audits.
- Requires BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background.
- BA/BS degree field of study in health care related field preferred.
- Specific education, years, and type of experience may be required based upon state law and contract requirements.
- Current unrestricted RN license in applicable state(s) preferred
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LTSS Transition Concierge Coordinator - Indiana, United States - Elevance Health
Description
Location:
Must be located in Indiana
The LTSS Transition Concierge Coordinator is responsible for supporting the LTSS Coordinator (or contracted provider) in completing components of the person-centered planning process, within Transitions of Care, for individuals enrolled in specialized programs, as required by applicable state law and contract, and federal requirements.
Develops, monitors, and assesses changes during any transitions of care into the Service Coordination forms and tools, such as the individual's Person-Centered Support Plan (PCSP) in accordance with member's needs and contributes to the components of the person-centered planning process to support individuals in meeting their established goals, in the setting of their choice, and accessing quality health care services and supports.
How you will make an impact:
Minimum Qualifications:
Preferred Skills, Capabilities, and Experience:
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler.
We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.
Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.