Wayne Counties

Elevance Health•Seven Hills, OH

7d•Hybrid

About The Position

The LTSS Service Coordinator (Case Manager) is responsible for managing service coordination for a designated caseload in specialized programs. 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. The MyCare Ohio health plan aims to deliver high-quality, trauma-informed, culturally competent, person-centered coordination for all members, addressing physical health, behavioral health, long-term services and supports, and psychosocial needs. The role involves collaborating with individuals to lead the Person-Centered Planning process, documenting preferences, needs, and goals. It also includes conducting assessments, creating comprehensive Person-Centered Support Plans (PCSP), and developing backup plans. The Service Coordinator will work with Medical Directors and participate in interdisciplinary care rounds to establish integrated care plans. They will engage the individual's support network and oversee the management of their physical health, behavioral health, and long-term services and supports, ensuring compliance with state and federal regulations.

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.
Must live in one of the following counties: Summit, Stark or Wayne County.
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.

Nice To Haves

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

Responsibilities

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.
Identifying members with potential clinical healthcare needs (including potential for high-risk complications, addressing gaps in care) and coordinating their cases with the clinical healthcare management and interdisciplinary team.
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 short and long-term service and support goals in collaboration with the member’s chosen care team (caregivers, family, natural supports, service providers, physicians).
Identifying members who would benefit from an alternative level of service or other waiver programs.
Serving as a mentor, subject matter expert, or preceptor for new staff, assisting in formal training.
Submitting utilization/authorization requests to utilization management with supporting documentation.
Reporting critical incidents to appropriate internal and external parties (e.g., state and county agencies, Adult Protective Services, Law Enforcement).
Assisting and participating in appeal or fair hearings, member grievances, appeals, and state audits.