Senior Care Services Coordinator

Riverside Health System • Williamsburg, VA

1d

About The Position

Works under the supervisor/director designated by the Executive Director of ChooseHome, in accordance with the plan of care based on a comprehensive health assessment and provides coordination /navigation of quality care services for members of ChooseHome. Health assessments with Choose Home members includes cognitive, functional, and psychosocial needs and interests to develop and coordinate appropriate services from within the community and Riverside Health System. Personal service coordinator communicates with participants and families adjusting to changes in level of care with appropriate resources within the ChooseHome provider network and the community. Provides education and assistance with developing advance directives, wellness, and preventative initiatives. Responsible for monthly service utilization reporting in managing a long-term care insured product. Community education on aging and caregiving support services, intake and coordinate referrals, and outreach and education of services related to successful aging and the five M's of geriatric care, Mind, Mobility, Medication, Multiplexity, and what matters most. Riverside services for older adults and caregivers. Track and measure data, using Salesforce, Point Click Care, and iCare. Identifies and recommends appropriate aging in place modification for home safety.

Requirements

• Bachelors Degree, Degree of study in Nursing/Social Work or Related (Preferred)
• 1 year experience in a customer service-oriented role with an older adult population (Required)
• 1 year Healthcare/Medical - Case Manager (Required)
• Valid Drivers License Required

Nice To Haves

• Registered Nurse (RN) - State Department of Health Professions (Preferred)
• Licensed Practical Nurse (LPN) - Virginia Department of Health Professions (VDHP) (Preferred)
• Licensed Clinical Social Worker (LCSW) - Virginia Department of Health Professions (VDHP) (Preferred)

Responsibilities

• Meets with new members in the ChooseHome program begin the relationship with the new member and answer any questions about the program.
• Educate Senior Care Navigation inquiries and clients as to appropriate and available resources, helping them make educated choices.
• Make initial decisions regarding eligibility for utilization of services or choose the best fitting vendor, if Riverside is unable to serve.
• Completes member assessments on an as needed, no less than annually, which includes an assessment of functional and cognitive changes.
• Utilizes provided tools to complete assessments.
• Acts as role model and mentor in assessment skills, consistently identifies subtle changes, follows through on client and intake.
• Maintains comprehensive records for all members to ensure appropriate utilization and accurate claim requests.
• Reports monthly on the cumulative utilization by members and referrals to and from Senior Care Navigation.
• Monitor provision of service to ensure client’s needs are met and regulations have been followed.
• Based on provided member assessments, coordinates and ensures the provision of services to meet member needs, as well as Senior Care Navigation coordination.
• Independently interprets the baseline of member’s care and changes level of care based on assessment and in conjunction with physician/provider notes as well as family communication and direct observation/home assessment.
• Apply clinical conditions of patient to requirements of contract utilization in Choose Home.
• Discusses, creates and documents advanced care plans for members.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees