LTSS Service Care Manager

Position Title : LTSS Service Care Manager Work Location : Cumberland County, NC (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 : ongoing work schedule 8-5 Mon-Fri EST Training Schedule : Training 8-5 Mon-Fri EST (3.5 weeks, cameras on, no time off); Work Arrangement : Hybrid - Remote 1-2 admin days per week; in-person member visits 3-4 days per week in the field (up to 1-4 visits per day; longer drive times may mean only 1 visit/day). Quarterly team meetings/training at Raleigh or Charlotte office 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. * 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