Service Coordinator (Care Management, Home & Community Based)- Fayette County (Hybrid)

UPMC•Connellsville, PA

15h•Hybrid

About The Position

UPMC Health Plan is hiring a Service Coordinator for its Community HealthChoices (CHC) team in Fayette County. 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 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 options and services to address individual health needs and promote quality, cost-effective outcomes. The role supports adults with complex medical, behavioral, and social needs, helping them remain safely and independently in their homes and communities. It involves a hybrid work arrangement, daily travel into the community, and field work at least 75% of the time. The Service Coordinator must be able to work independently in a virtual setting and maintain a private, distraction-free workspace.

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.
Strong background in case management and care coordination, including experience conducting in-home assessments and visits.
Demonstrated ability to work effectively with adults who have complex medical, behavioral, and social needs.
Compassionate, resourceful, and committed to helping participants remain safely and independently in their homes and communities.
Cultural competency and ability to be sensitive to diverse backgrounds and 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.
Internet connection with at least 20 Mb/s download, 5 Mb/s upload, less than 50 ms ping, and under 10 ms jitter.

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 by regulatory deadlines.
Perform professional administrative work involving research, analysis, and reporting; prepare service-provision reports and update service plans in accordance with governing bodies.
Ensure comprehensive assessments are completed within required time frames and assess care options using knowledge of benefits and community resources.
Lead the Person-Centered Service Planning (PCSP) process and oversee implementation of PCSPs; assist Members in obtaining HCBS services 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.
Inform Members about available LTSS, required assessments, the PCSP process, service alternatives and delivery options (including self-direction), roles, rights (including DHS Fair Hearing rights), risks, and responsibilities; assist with requested fair hearing requests when needed.
Gather information about Member preferences, strengths, and goals to inform the PCSP; conduct level-of-care reevaluations annually or more often as needed; and assist Members and their PCPTs in identifying and choosing willing, qualified providers.
Work with Members to complete activities needed to maintain LTSS eligibility and explore coverage for 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 among physical, behavioral, and support services.
Comply with state and federal regulations and guidelines, protect Member health, welfare, and quality of life on an ongoing basis, and maintain confidentiality in accordance with HIPAA.
Work in the field at least 75% of the time and work independently in a virtual setting.