LTSS Service Care Manager

Position Title: LTSS Service Care Manager

Work Location: Pitt County, NC area (candidates must be within up to 2.5-hour one-way radius from home residence for face-to-face member visits; mileage and lodging reimbursed if needed)

Assignment Duration: 6 months (possibility to extend or convert)

Work Schedule: 8-5 Mon-Fri EST

Work Arrangement: Hybrid (Remote 1-2 admin days a week; In-person visits 3-4 days a week in field; up to 1-4 visits a day.

Quarterly in-office team meeting/training at Raleigh or Charlotte locations)

Position Summary :

Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. Will develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs. Member facing but potentially provider facing.

Key Responsibilities :

* Managing a case load for healthcare members with LTSS (Long Term Support/Services) needs.

* Monthly and quarterly member contact and will include 80% travel. Remote role. Will require a driver's license.

* Member assessments and notes.

* Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development.

* Monitor delivery of services and follow-up with members, caregivers, or providers through in person visits and telephonic contact.

* Authorize and coordinate referral for services.

* Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care.

* Assist in coordinating the development of informal or voluntary services to integrate into the member care plan.

* Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care services.

* Assist member with filing and resolving complaints and appeals. Education/Certification
Required: Bachelor's
Preferred:

Licensure
Required: RN and/or LCSW/LCSW-A/BSN/ADN
Preferred:

Years of experience required: 2-4+ years of physical health care management experience, 4-6+ years of physical health care management experience preferred. Hospital CM, Home health, discharge planning, or long-term care experience preferred. Case management and care planning experience.

Preferred - Home health experience, community health/member facing, discharge planning

Disqualifiers: No Psych experience such as counseling (must have bedside case management hospital physical as well) no Right out of nursing school. No Nursing homes. No rehab.

Additional qualities to look for: Virtual, All Microsoft office, Experience with electronic medical health records

• Top 3 must-have hard skills stack-ranked by importance

1
Physical hospital Health, Care Management, Utilization Mgt, Home Health - all and/or background

2
Microsoft office - Tech savvy

3
Bedside care management