About The Position
UPMC Health Plan is hiring Service Coordinators for its Community HealthChoices (CHC) team serving Blair and Cambria Counties. CHC is Pennsylvania’s managed care long-term services and supports (LTSS) program for seniors and people with physical disabilities covered by Medicare and Medicaid. The Service Coordinator provides community-based coordination across the continuum of care to improve Members’ health outcomes. This collaborative process assesses, plans, implements, coordinates, monitors, and evaluates services and options that address individual health needs, using communication and available resources to promote quality, cost-effective outcomes. The role supports Members in remaining safely and independently in their homes and communities, including coordinating LTSS, medical, behavioral, social, housing, educational, and other services. This is a hybrid position involving daily travel in the community, with fieldwork at least 75% of the time. The coordinator must also be able 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, 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 about 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 within regulatory deadlines and compliance requirements.
- Perform professional-level administrative duties 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, 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-funded medical, social, housing, educational, and other services and supports.
- Provide information about available LTSS, required assessments, the person-centered service-planning process, service alternatives and delivery options, self-direction opportunities, roles, rights, risks, and responsibilities; assist with fair-hearing requests when needed and requested.
- Protect Members’ 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 Team (PCPT) 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 other community resources.
- Coordinate with individuals and entities involved in Members’ physical and behavioral care to support seamless coordination among physical, behavioral, and support services.
- Comply with state and federal regulations and guidelines in daily work, maintain confidentiality, and adhere to HIPAA requirements.
- Work in the field at least 75% of the time and work independently in a virtual setting.
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What This Job Offers
Job Type
Full-time
