Wayne Counties

Elevance Health•Akron, OH

6d•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 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 role involves collaborating with individuals to lead the Person Centered Planning process, documenting their 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 partake in interdisciplinary care rounds to establish a fully integrated care plan. They will 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.

Requirements

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

Nice To Haves

Strong preference for case management experience with older adults or individuals with disabilities.
BA/BS in Health/Nursing 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.
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.
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, and potentially involved in process improvement initiatives.
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.
Assisting and participating in appeal or fair hearings, member grievances, appeals, and state audits.