LTSS Service Coordinator - Case Manager (Region G: Palm Beach County)

Elevance Health•West Palm Beach, FL

9d•Onsite

About The Position

The LTSS Service Coordinator conducts service coordination for a defined caseload of individuals in specialized programs. In collaboration with each person supported, the coordinator facilitates person-centered planning to document preferences, needs, and self-identified goals. This includes conducting assessments, developing a comprehensive Person Centered Support Plan (PCSP) and backup plan, interfacing with Medical Directors, and participating in interdisciplinary care rounds to support an integrated care plan. The coordinator engages the member’s circle of support and manages physical health, behavioral health, and long-term services and supports needs as required by applicable laws, contracts, and federal requirements. This primarily field-based role serves members in specialized programs, including LTSS and IDD waivers. The coordinator conducts face-to-face assessments, supports care coordination and utilization, manages non-clinical needs, and works with members and their chosen care teams to identify and pursue service and support goals. The role may also involve mentoring or training new staff, process improvement, reporting critical incidents, and participating in appeals, grievances, fair hearings, and state audits.

Requirements

BA/BS degree and a minimum of 2 years of experience working with a social work agency, or an equivalent combination of education and experience.
Specific education, years, and type of experience may be required based on state law and contract requirements.
Bilingual in Spanish and English.
Must reside in Indian River, Martin, or Palm Beach County, or potentially an alternate location within commuting distance of an office.

Nice To Haves

BA/BS degree in a healthcare-related field.
Bilingual in English and Spanish.
Experience in LTSS, case management, social work, or hospital discharge planning.

Responsibilities

Conduct face-to-face program assessments using tools with predefined questions to identify member needs.
Use motivational interviewing techniques for evaluations, coordination, and management of waiver, behavioral health, and physical health needs.
Identify members with potential clinical healthcare needs, including high-risk complications or gaps in care, and coordinate their cases as a single point of contact with clinical healthcare management and the interdisciplinary team.
Manage members’ non-clinical needs related to chronic illnesses, co-morbidities, and 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’s 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 other waiver programs.
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.
Assist with and participate in appeal or fair hearings, member grievances, appeals, and state audits.
May mentor, serve as a subject matter expert or preceptor for new staff, assist with formal training, and participate in process improvement initiatives.