Clinical - LTSS Service Care Manager - LTSS Service Care Manager

Care Management Specialist

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May 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.

Education/Experience: Requires a Bachelor's degree and 2 – 4 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification: For Iowa Only: Bachelor's degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least two years of experience in the delivery of services to the population groups or current state's Registered Nurse (RN) license and at least four years of experience required. For North Carolina Standard Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services. RN or LCSW required. For North Carolina Tailored Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services. RN or LCSW / LCSW-A preferred.

Responsibilities:

• Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
• Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members
• Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans
• Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
• Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met
• Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• May perform home and/or other site visits to assess member's needs and collaborate with healthcare providers and partners
• Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
• Performs other duties as assigned
• Complies with all policies and standards

Story Behind the Need – Business Group & Key Projects:

Health plan or business unit: Team culture, surrounding team & key projects, purpose of this team, reason for the request, motivators for this need, any additional upcoming hiring needs? - Stabilizing Long term care workforce, supporting and maintaining compliance as we continue into our new contract requirements effective 2/1/25. We were awarded the entire state for the new state contract. Opportunity for promoting and growth from within the company. Promotional opportunity who wants to grow within the company and continue to develop even across to other lines of business. We have a diverse team as our membership is diverse. Having a diverse workforce only helps the plan to better serve our members. The interview panel will consist of a diverse panel.

Typical Day in the Role:

Daily schedule & OT expectations: Typical task breakdown and rhythm, interaction level with team, work environment description: Southern Palm Beach County is the target location. Prefer Spanish Speaking. This is a remote position working from a home office. The position will be 8 to 5 with the possibility of participating in a flex work week after being hired on FTI (to be reviewed/approved by leadership based on performance in the role). The team has a strong longevity and many of the team have been a part of the team for years. This role is remote but also requires field work – while allows for a self-made independent role. They can build and schedule their meetings throughout the week. Interacting with members, family members, providers and other departments to ensure member's needs are being met. Member/provider requests/issues/concerns. Visit members in field and return to home office to complete documentation.

Compelling Story & Candidate Value Proposition:

What makes this role interesting? Points about team culture, competitive market comparison, unique selling points, value added or experience gained - managing difficult members, multiple priorities. Positive attitude, problem solver/solutions oriented, empathy while ensuring business needs are met.

Candidate Requirements:

Education/Certification - Required: Requires a Bachelor's degree and 2 – 4 years of related experience - Preferred: n/a

Licensure - Required: Drivers License - Preferred: n/a

Years of experience required, disqualifications, best vs. average, performance indicators - experience with field based case management, remote work, average CL #, home visits, care plan development, experience with type of assessments. 2+ years of Care Management experience (field experience is a must). Caseloads of 50,60,70 members – bonus if it is geriatric. Long Term Care Medicaid experience. Medicaid / Medicare experience. Need to see experience being able to manage high case load. Fast paced environment regarding new processes and programs. They must be comfortable being able to connect with IT should their equipment fail in the field, etc. or be able to go into an office location or IT space. All documentation must be within system within 24 hours of completion. Experience with electronic medical health records. Home Health Experience. Prefer experience working with TruCare which is the software the team uses. Experience in Case Management in senior services, state agencies. Team Player, problem solver, solutions oriented, member centric, integrity.