LTSS Service Care Manager

LTSS Service Care Manager

The LTSS Service Care Manager assists in developing, assessing, and coordinating holistic care management activities to support quality, cost-effective healthcare outcomes. This role develops and manages personalized service care plans for Long-Term Services and Supports (LTSS) members and educates members and their families/caregivers on available services and benefits.

This is a member-facing role requiring regular in-person visits, care coordination, assessments, and collaboration with healthcare providers and community resources.

Responsibilities:

• Manage a caseload of healthcare members with Long-Term Support Services (LTSS) needs.
• Conduct member assessments and develop individualized care/service plans.
• Complete assessments with members, caregivers, and providers to understand client status, support systems, and service needs.
• Monitor delivery of services through in-person visits and telephonic follow-ups.
• Coordinate referrals and authorize services as needed.
• Ensure provider services are delivered without gaps and identify deficiencies in care plans.
• Collaborate with discharge planners, physicians, healthcare providers, and community partners.
• Support coordination of acute care and long-term care services.
• Assist members with complaints, appeals, and service-related concerns.
• Maintain accurate documentation and ensure compliance with state, federal, and payer regulations.
• Provide education to members and families regarding healthcare benefits, procedures, referrals, and service options.
• Identify opportunities to improve quality of care and service delivery.

Field Requirements:

• Remote role with 1–2 administrative days per week.
• In-person member visits 3–4 days per week.
• Travel may include up to 2.5 hours one way from home residence.
• Mileage and lodging expenses reimbursed when applicable.
• Valid driver's license required.

Required Qualifications:

• Bachelor’s degree required.
• RN or LCSW/LCSW-A required.
• 2–4+ years of physical healthcare management experience required.
• 4–6 years of experience preferred.
• Experience in hospital case management, home health, discharge planning, utilization management, or long-term care preferred.

Preferred Experience:

• Community health/member-facing experience.
• Care planning and case management experience.
• Electronic Medical Records (EMR) experience.
• Strong Microsoft Office and technology skills.

Required Skills:

• Physical healthcare management background.
• Care management/utilization management experience.
• Bedside case management experience.
• Strong communication and documentation skills.