LTSS Service Care Manager

Position Title: LTSS Service Care Manager

Work Location: Florida - Pinellas County ( All candidates must reside in Pinellas- Spanish speaking is preferred)

Assignment Duration: 12 months ( Possible extension OR conversion )

Work Schedule: 8-5 Mon-Fri

Work Arrangement: Field-based / Member-facing (80-90% )

Position Summary: 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.

Background & Context: Sunshine State Health Plan role focused on geriatric long-term care with significant field work.

Key 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

Qualification & 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.

* Valid driver's license required.

* For specific states, additional requirements apply (e.g., RN or LCSW in some plans).

Working Conditions & Physical Demands: Will be in the field 80-90% of the time. 8-5 Mon-Fri. Requires driver's license and comfort with member-facing field work and travel.

Candidate Requirements

Required: Requires a Bachelor's degree and 2 - 4 years of related experience. (Bachelors Degree should be within the realm of Healthcare) - Psychology, Sociology, etc.

Field experience would need to be long term to have the team consider someone that does not have a degree within the space they are looking for.
Preferred: n/a

Required: Valid driver's license
Preferred: n/a

• Years of experience required
• Disqualifiers
• Best vs. average
• Performance indicators

Must haves:

• 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

Nice to haves:

1. Discharge Planning
2. Working with TruCare which is the software the team uses

Disqualifiers:

• Not having field experience
• Not having previous experience with high caseloads

Performance indicators: Bilingual always preferred - req will indicate if Bilingual is required via the notes section

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1
2 years of field case management

2
Technology Savy

3
Must be able to look at calendar and manage time - ensuring enough time for documentation