Service Coordinator (Care Management, Social Work)- Berks County

UPMC•Camp Hill, PA

4d•Hybrid

About The Position

UPMC Health Plan is hiring a Service Coordinator for its Community HealthChoices (CHC) team in Berks County. CHC is Pennsylvania’s managed care long-term services and supports (LTSS) program for seniors and individuals with physical disabilities who are covered by Medicare and Medicaid. The Service Coordinator provides community-based service coordination across the continuum of care to improve member health outcomes. This collaborative process assesses, plans, implements, coordinates, monitors, and evaluates services and options that address individual health needs through communication and available resources, with the goal of promoting quality, cost-effective outcomes. The role serves adults with complex medical, behavioral, and social needs and supports participants in remaining safely and independently in their homes and communities. This is a hybrid position involving daily travel into the community, with field work at least 75% of the time. The position also requires 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 speed of at least 20 Mb/s download and 5 Mb/s upload, ping under 50 ms, and jitter under 10 ms.
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 in need of 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 working relationships with internal team members and partner providers to foster collaboration.
Educate members about and coordinate community resources, including medical, behavioral, and social services.
Manage an active caseload in accordance with state-mandated ratios based on residential setting, case intensity, and acuity.
Collect monthly program data on participant progress and complete OPS reporting by regulatory deadlines and in accordance with compliance requirements.
Perform profession-level administrative duties involving research, analysis, and reporting; prepare service-provision reports and update service plans in accordance with governing bodies.
Complete comprehensive assessments within required time frames and assess care options, including 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 needed LTSS and Medical Assistance services, as well as non-Medicaid medical, social, housing, educational, and other services and supports.
Provide information about available LTSS, required assessments, the person-centered planning process, service alternatives and delivery options, self-direction opportunities, roles, 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 level of care annually or more frequently as needed.
Assist members and their PCPT 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 coordination of physical, behavioral, and support services.
Comply with state and federal regulations and guidelines, maintain confidentiality, and follow HIPAA requirements.
Work in the field at least 75% of the time and work independently in a virtual setting.