LTSS Service Coordinator (Case Manager) Eastern Ohio

Elevance Health•Carrollton, OH

33d•$26 - $39•Hybrid

About The Position

The LTSS Service Coordinator manages service coordination for a designated caseload in specialized programs under the MyCare Ohio health plan. The plan provides high-quality, trauma-informed, culturally competent, person-centered coordination addressing members’ physical health, behavioral health, long-term services and supports, and psychosocial needs. This field-based role primarily involves travel to client sites or other designated locations, with occasional office attendance for meetings or training. Candidates must live in one of the listed Ohio counties and be within reasonable commuting distance of a posting location or office, unless an accommodation is granted as required by law. The coordinator leads the Person Centered Planning process with individuals, documents their preferences, needs, and goals, conducts assessments, creates Person Centered Support Plans (PCSPs) and backup plans, and works with Medical Directors and interdisciplinary teams to establish integrated care plans. The role engages members’ support networks and coordinates physical health, behavioral health, and long-term services and supports in accordance with state and federal regulations.

Requirements

Bachelor’s degree and at least 2 years of experience working with a social work agency, or an equivalent combination of education and experience.
Must reside in one of the counties listed in the posting.
Must be within reasonable commuting distance of a posting location or office, unless an accommodation is granted as required by law.

Nice To Haves

Case management experience with older adults or individuals with disabilities is strongly preferred.
BA/BS in Health or Nursing preferred.

Responsibilities

Conduct face-to-face program assessments using tools with predefined questions to identify needs, and apply motivational interviewing techniques for evaluation, coordination, and management of waiver, behavioral health, and physical health needs.
Identify members with potential clinical healthcare needs, including high-risk complications and gaps in care, and coordinate cases as the single point of contact with clinical healthcare management and interdisciplinary teams.
Manage members’ non-clinical needs related to chronic illnesses, comorbidities, or disabilities to support cost-effective and efficient use of long-term services and supports.
Document members’ short- and long-term service and support goals in collaboration with the member and their chosen care team, which may include caregivers, family, natural supports, service providers, and physicians.
Identify members who may benefit from an alternative level of service or another waiver program.
Create comprehensive Person Centered Support Plans and backup plans, and collaborate with Medical Directors and interdisciplinary care teams on integrated care plans.
Submit utilization and authorization requests to utilization management with documentation aligned with the individual’s care plan.
Report critical incidents to appropriate internal and external parties, including state and county agencies such as Adult Protective Services and law enforcement.
Assist with and participate in appeals or fair hearings, member grievances and appeals, and state audits.
May mentor, serve as a subject matter expert or preceptor for new staff, assist with formal associate training, and participate in process improvement initiatives.