LTSS Service Care Manager

Position Title: LTSS Service Care Manager

Work Location: All candidates must reside in the city of Sarasota. Spanish speaking preferred.

Assignment Duration: 12 months; possible to extend or convert

Work Schedule: 8-5 Mon-Fri

Work Arrangement: Field-based and member-facing; in the field 80-90% of the time. Administrative work is remote. Not based in an organization facility.

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: Supports long-term services and supports (LTSS) members on a Florida Medicaid health plan. Work is independent field care management for members with long-term care needs, with a geriatric long-term care focus. The assignment has a hard start tied to an assigned trainer and may extend or convert based on performance and eligibility.

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
• Managing a case load for healthcare members with long term care needs
• Geriatric long term care
• Member assessments and notes
• 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
• Monthly and quarterly member contact

Qualification & Experience:

Candidate Requirements Education/Certification 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 Licensure 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 Position is offered by a no fee agency.