LTSS Service Coordinator - Case Manager (Region I: Miami-Dade/Monroe County)

• Responsible for performing face to face program assessments (using various tools with pre-defined questions) for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual's waiver (such as LTSS/IDD), and BH or PH needs.
  
• Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high-risk complications, addresses gaps in care) and coordinates those member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.
  
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports.
  
• At the direction of the member, documents their short and long-term service and support goals in collaboration with the member's chosen care team that may include, caregivers, family, natural supports, service providers, and physicians.
  
• Identifies members that would benefit from an alternative level of service or other waiver programs.
  
• May also serve as mentor, subject matter expert or preceptor for new staff, assisting in the formal training of associates, and may be involved in process improvement initiatives.
  
• Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.
  
• Responsible for reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement).
  
• Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits.
  

• Requires BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background.
  
• Specific education, years, and type of experience may be required based upon state law and contract requirements.
  

• BA/BS degree field of study in health care related field preferred.
  
• Bilingual in English/ Spanish strongly preferred.
  
• LTSS, case management, social work or hospital discharge planning experience preferred.
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on us.fitly.work for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act