LTSS Service Care Manager

Responsibilities:

• LTSS service care manager will have 3 days of travel for visits seeing the members in their home and 2 days working remote for documentation of assessments as well as any follow up and tasks required to work . SC will be assessing the member for approval or denial of personal attendant services to assist with Activities of daily living by filling out a H2060 form in the field .
• LTSS Service CM will fill out a required assessment and all forms, document their assessments and submitting for authorization or denial of services within a 3Business day turnaround.
• Evaluates the needs of the most complex and high risk members and recommends a plan of care for the best outcome
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies
• Provides and/or facilitates education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits.
• Educates on and coordinates community resources, to include medical and social services. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
• Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources. Ensures identified services are accessible to members
• Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system. Works to ensure compliance with clinical guidelines as well as current state and federal guidelines
• 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

Must haves:

Working with the aged, blind, or disabled population 5+ years or more. Bilingual strongly preferred

Nice to haves:

Social Service/ Social Work/ Care Management / Services Coordination Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Nursing/ LVN/ Medical