CHC Service Coordinator (Care Management, Home & Community Based)- Monroe Pike, PA- (Hybrid)

UPMC•Tobyhanna, PA

1d•Hybrid

About The Position

UPMC Health Plan is hiring a Service Coordinator for its Community HealthChoices team in the Monroe Pike, Pennsylvania area. The role provides community-based service coordination across the continuum of care to improve outcomes for members covered by Medicare and Medicaid who are seniors or people with physical disabilities. Service coordination involves assessing, planning, implementing, coordinating, monitoring, and evaluating services and options to meet members’ health needs using communication and available resources to promote quality, cost-effective outcomes. The Service Coordinator manages an active caseload and leads person-centered service planning. The role helps members access long-term services and supports (LTSS), Medical Assistance services, and other medical, social, housing, educational, and community resources. The position is hybrid and requires daily community travel, with field work at least 75% of the time, as well as the ability to work independently in a virtual setting.

Requirements

Bachelor’s degree in social work, psychology, or a related field with practicum experience, or at least three years of experience in a social service or healthcare-related setting.
Valid driver’s license.
Reliable transportation.
Private workspace free from distractions.
Ability to meet strict regulatory deadlines and protect confidentiality in accordance with HIPAA guidelines.
Internet connection with at least 20 Mb/s download, 5 Mb/s upload, less than 50 ms ping, and under 10 ms jitter.
Cultural competency and sensitivity to diverse backgrounds, including the ability to set aside personal opinions and implicit biases.

Nice To Haves

Experience working with people with disabilities or seniors who need LTSS.
Knowledge of the home- and community-based services system and how to access and arrange services.
At least one year of LTSS, service coordination, or case management experience.

Responsibilities

Build strong relationships with internal team members and partner providers to foster collaboration; educate members on and coordinate community resources, including medical, behavioral, and social services.
Manage an active caseload according to state-mandated ratios based on residential setting, case intensity, and acuity.
Collect monthly program data to track participant progress and complete OPS reporting by regulatory deadlines.
Perform professional administrative duties involving research, analysis, and reporting; prepare reports on services and update service plans in accordance with governing requirements.
Ensure comprehensive assessments are completed within required time frames and assess care options, benefits, and community resources.
Lead the Person-Centered Service Planning (PCSP) process and oversee implementation of PCSPs.
Assist members in obtaining home- and community-based services (HCBS) that support independent living.
Identify, coordinate, and help members access LTSS, Medical Assistance services, and other Medicaid-funded or non-Medicaid medical, social, housing, educational, and support services.
Inform members about LTSS, required assessments, the person-centered planning process, service alternatives and delivery options, self-direction opportunities, roles, rights (including DHS Fair Hearing rights), risks, and responsibilities; assist with fair hearing requests when needed and requested.
Gather information about member preferences, strengths, and goals to inform PCSP development.
Reevaluate members’ level of care annually or more often as needed.
Assist members and their Person-Centered Planning Teams (PCPTs) in identifying and choosing willing and qualified providers.
Work with members on activities needed to maintain LTSS eligibility and explore coverage through Medical Assistance, Medicare, private insurance, and community resources.
Coordinate with individuals and entities involved in members’ physical and behavioral care to support seamless delivery of physical, behavioral, and support services.
Comply with state and federal regulations and guidelines, maintain confidentiality, and adhere to HIPAA requirements.
Work in the field at least 75% of the time and work independently in a virtual setting.