LTSS Concierge Coordinator

Elevance Health•Nashville, TN

1d•Remote

About The Position

The LTSS Concierge Coordinator is responsible for supporting the LTSS Coordinator (or contracted provider) in completing components of the person-centered planning process for individuals enrolled in specialized programs, as required by applicable state law and contract, and federal requirements. Develops, monitors, and revises 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. This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidate must reside within the state of Tennessee.

Requirements

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.

Nice To Haves

Strong computer skills to include Excel, Outlook and Electronic Medical Records highly preferred.
BA/BS degree field of study in health care related field preferred.
Strong preference for case management experience with older adults or individuals with disabilities.
Specific education, years, and type of experience may be required based upon state law and contract requirements.

Responsibilities

Performing telephonic and/or virtual outreach to individuals in specialized programs, providers, or other key stakeholders 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 LTSS waiver, behavioral health or physical health needs.
Submitting utilization/authorization requests to utilization management with documentation supporting and aligning with the individual’s care plan.
Utilizing tools and pre-defined identification process, consults with the primary service coordinator to monitor the PCSP, in instances in which a risk is identified related to the members LTSS, physical or behavioral health supports (including, but not limited to, potential for high-risk complications).
Engaging the primary service coordinator and other clinical healthcare management and interdisciplinary teams to provide care coordination support.
Managing non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports.
At the direction of the member, documenting 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.
Identifying members that would benefit from an alternative level of service or other waiver programs.
Serving as mentor, subject matter expert or preceptor for new staff, assisting in formal training of associates and may be involved in process improvement initiatives.
Reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement).
Assisting and participating in appeal or fair hearings, member grievances, appeals and state audits.