Medicare Long Term Services & Support Care Coordinator
About The Position
At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Role Overview: Reporting to the Supervisor of Medicare LTSS Operations, the Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical, behavioral health, Long-Term Services & Supports (LTSS), and psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the scope of licensure.
Requirements
- A master's degree in Social Work required or active licensure as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Master Social Worker (LMSW) required.
- Minimum of 3 years of experience in care coordination, case management, or related roles serving individuals with chronic conditions or disabilities.
- Strong understanding of Medicare-Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.
- Ability to communicate effectively with diverse populations, including those with communication barriers or assistive technology needs.
- Active licensure as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Master Social Worker (LMSW) required.
- Ability to communicate effectively with diverse populations, including those with communication barriers or assistive technology needs.
- Strong decision-making, organizational, and quality assurance skills.
Nice To Haves
- Field experience preferred
- Proficiency in Microsoft Office Suite (Word, Excel, etc.).
Responsibilities
- Deliver comprehensive care coordination for Medicare members receiving LTSS and custodial care.
- Conduct telephonic and in-person clinical assessments to evaluate members' physical, behavioral, social, and long-term care needs.
- Identify high-risk members and collaborate with the Integrated Care Team to develop and implement individualized care plans.
- Coordinate services for members with chronic conditions, co-morbidities, and disabilities to promote efficient, cost-effective care.
- Gather detailed member histories and establish personalized care goals with members, caregivers, families, and providers.
- Facilitate access to appropriate services through referrals and authorizations, including home- and community-based programs.
- Collaborate with the Medical Director and care team to develop and monitor treatment plans.
- Address service issues and assist with provider or claims-related problem-solving.
- May oversee tasks assigned to other licensed or unlicensed professionals involved in member care coordination.
- Maintain up-to-date knowledge of CMS and Department of Health & Human Services (DHHS) regulations, licensure requirements, and internal policies.
- Promote a culture of teamwork, respect, diversity, and continuous improvement.
Benefits
- Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays, volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Insurance Carriers and Related Activities
Number of Employees
5,001-10,000 employees
