CHC Service Coordinator (Case Management, Social Work) - Lehigh Valley (Hybrid)

UPMC•Allentown, PA

17h•Hybrid

About The Position

UPMC Health Plan is hiring Service Coordinators for its Community HealthChoices (CHC) team in the Lehigh Valley. CHC is Pennsylvania’s managed care long-term services and supports (LTSS) program for seniors and people with physical disabilities who are covered by Medicare and Medicaid. The role provides community-based service coordination across the continuum of care to improve member health outcomes. Service coordination is a collaborative process involving assessment, planning, implementation, coordination, monitoring, and evaluation of options and services that meet members’ health needs through communication and available resources, with the goal of quality, cost-effective outcomes. This is a hybrid position requiring daily travel into the community and field work at least 75% of the time. The Service Coordinator manages a caseload and coordinates LTSS, Medical Assistance, and other medical, behavioral, social, housing, educational, and community services. The position leads person-centered service planning, supports members’ access to services and independent living, monitors needs and progress, and ensures compliance with regulatory requirements and confidentiality standards. The job 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.
Cultural competency and sensitivity to diverse backgrounds, including the ability to set aside personal opinions and implicit biases.
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.
Minimum internet speed of 20 Mb/s download and 5 Mb/s upload, ping under 50 ms, and jitter under 10 ms.
Willingness and ability to work in the field at least 75% of the time.
Ability to work independently in a virtual setting.

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 about and coordinate access to community resources, including medical, behavioral, and social services.
Manage an active caseload in accordance with state-mandated ratios, residential setting, case intensity, and acuity.
Collect program data to track participant progress monthly and complete OPS reporting by regulatory deadlines.
Perform administrative work involving research, analysis, and reporting; prepare reports on service provision and update service plans according to governing body requirements.
Complete comprehensive assessments 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 non-Medicaid-funded medical, social, housing, educational, and other services and supports.
Provide information about available LTSS, assessments, person-centered planning, service alternatives and delivery options, self-direction, member rights and responsibilities, risks, and DHS Fair Hearing rights.
Assist members with fair hearing requests when needed and requested, and help protect their health, welfare, and quality of life on an ongoing basis.
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 Person-Centered Planning Teams (PCPTs) in identifying and choosing willing and qualified providers.
Work with members to complete activities needed to maintain LTSS eligibility.
Explore coverage for member-identified needs 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 adhere to HIPAA requirements.