LTSS Service Coordinator - Case Manager (Region I: Miami-Dade/Monroe County)

Elevance Health•Hialeah Gardens, FL

1d•Onsite

About The Position

The LTSS Service Coordinator is responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs. In collaboration with the person supported, facilitates the Person Centered Planning process that documents the member’s preferences, needs and self-identified goals, including but not limited to conducting assessments, development of a comprehensive Person Centered Support Plan (PCSP) and backup plan, interfacing with Medical Directors and participating in interdisciplinary care rounds to support development of a fully integrated care plan, engaging the member’s circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs, as required by applicable state law and contract, and federal requirements. This is primarily a field-based position requiring the candidate to reside in Miami-Dade or Monroe county. The role involves traveling to client sites or designated locations, with occasional office attendance for meetings or training. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

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.
Specific education, years, and type of experience may be required based upon state law and contract requirements.

Nice To Haves

BA/BS degree field of study in health care related field preferred.
Bilingual in English/ Spanish strongly preferred.
LTSS, case management, social work or hospital discharge planning experience preferred.

Responsibilities

Performing face to face program assessments for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver (such as LTSS/IDD), and BH or PH needs.
Identifying members with potential clinical health care needs and coordinating those member’s cases with the clinical healthcare management and interdisciplinary team 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.
Documenting member’s short and long-term service and support goals in collaboration with the member’s chosen care team.
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 the formal training of associates.
Submitting utilization/authorization requests to utilization management with documentation supporting and aligning with the individual’s care plan.
Reporting critical incidents to appropriate internal and external parties such as state and county agencies.
Assisting and participating in appeal or fair hearings, member grievances, appeals, and state audits.