LTSS Service Coordinator (Case Manager)

Elevance Health-posted about 1 month ago
Full-time • Entry Level
Hybrid • Ashtabula, OH
5,001-10,000 employees
Insurance Carriers and Related Activities
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LTSS Service Coordinator (Case Manager) Hiring near Ashland, Ashtabula, Bucyrus, Mansfield, Marion, Mt. Gilead, Mt. Vernon, Norwalk, Salem, Upper Sandusky, Tiffin, Warren, Youngstown Location: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, 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. The MyCare Ohio health plan is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The LTSS Service Coordinator is responsible for managing service coordination for a designated caseload in specialized programs. Collaborate with individuals to lead the Person Centered Planning process, documenting their preferences, needs, and goals. Conduct assessments, create comprehensive Person Centered Support Plans (PCSP), and develop backup plans. Work with Medical Directors and partake in interdisciplinary care rounds to establish a fully integrated care plan. Engage the individual's support network and oversee management of their physical health, behavioral health, and long-term services and supports, adhering to state and federal regulations.

  • Responsible for performing face to face program assessments (using various tools with pre-defined questions) 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.
  • Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high-risk complications, addresses gaps in care) and coordinates those member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.
  • Manages 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.
  • At the direction of the member, documents their short and long-term service and support goals in collaboration with the member's chosen care team that may include, caregivers, family, natural supports, service providers, and physicians. Identifies members that would benefit from an alternative level of service or other waiver programs.
  • May also serve as mentor, subject matter expert or preceptor for new staff, assisting in the formal training of associates, and may be involved in process improvement initiatives.
  • Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.
  • Responsible for reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement).
  • Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits.
  • Requires 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.
  • Strong preference for case management experience with older adults or individuals with disabilities.
  • BA/BS in Health/Nursing preferred.
  • We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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