LTSS Service Care Manager

Centene Corporation•Orlando, FL

1d•Hybrid

About The Position

Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs. Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome. Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care. Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members. Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans. Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs. Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met. Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators. May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners. Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits. Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner. Performs other duties as assigned. Complies with all policies and standards. Travel is required for member visits.

Requirements

Requires a Bachelor's degree and 2 – 4 years of related experience, or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Travel is required for member visits.

Nice To Haves

Candidates with Social Worker or Case Manager experience and/or an educational background in Social Work, Psychology, Behavioral Science, or Masters level - Social Work is preferred.
3+ years of case management experience working directly with members with complex medical conditions and disabilities.
2+ years of experience coordinating and managing medical, DME, referral services, and providing patient advocacy and education to Medicaid members.
Experience in FIELD-BASED case management or service coordinator roles in community health, managed care, or state health and human services settings.
Service Delivery Zip Code Area: 32703, 32712, 32751, 32789, 32804, 32808, 32810, 32818 or 32835.

Responsibilities

Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes.
May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.
Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome.
Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care.
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members.
Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans.
Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs.
Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met.
Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners.
Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits.
Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
Performs other duties as assigned.
Complies with all policies and standards.