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

Elevance Health•Miami Gardens, FL

3d•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 LTSS needs as required by applicable state law, contract, and federal requirements. This is a primarily field-based position serving members in Miami-Dade or Monroe County, Florida. The schedule is Monday through Friday, 8 a.m. to 5 p.m. EST. Field work involves travel to client sites or designated locations, with occasional office attendance for meetings or training. The role requires bilingual Spanish and English communication.

Requirements

Bachelor’s degree (BA/BS) and at least 2 years of experience working with a social work agency, or an equivalent combination of education and experience.
Bilingual in Spanish and English.
Specific education, years, and type of experience may be required based on state law and contract requirements.
Reside in Miami-Dade or Monroe County, or within a reasonable commuting distance from a posting location.

Nice To Haves

BA/BS degree in a health care-related field.
Bilingual English/Spanish skills are strongly preferred.
Experience in LTSS, case management, social work, or hospital discharge planning.

Responsibilities

Conduct face-to-face program assessments using tools with predefined questions, applying motivational interviewing techniques to evaluate and coordinate members’ waiver, behavioral health, or physical health needs.
Identify members with potential clinical health care needs, including potential high-risk complications and gaps in care, and coordinate cases as the single point of contact with clinical health care management and the interdisciplinary team.
Manage members’ non-clinical needs related to chronic illnesses, co-morbidities, and disabilities to support cost-effective and efficient utilization of long-term services and supports.
Document 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 or authorization requests to utilization management with documentation aligned with the individual’s care plan.
Report critical incidents to appropriate internal and external parties, such as state and county agencies, Adult Protective Services, and law enforcement.
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 associate training, and participate in process improvement initiatives.