Care Coordinator

3 days ago

Dover, Delaware, United States Highmark Health Full time
Job Summary

This role serves as the primary point of contact for members to coordinate all of their care needs across various service delivery systems and community supports. As a full-time community-based position, frequent travel within the assigned territory in DE is required. The incumbent will travel to members' homes, nursing facilities, and other community-based settings for individuals enrolled in DSHP Plus LTSS.

Key Responsibilities
  • Conduct face-to-face needs assessments with members, followed by telephonic contact, in accordance with state and national guidelines, policies, procedures, and protocols.
  • Assess, plan, coordinate, implement, and evaluate care for eligible members with chronic and complex healthcare, social service, and custodial needs in nursing facilities or home and community-based care settings.
  • Coordinate care across the continuum of services, assisting members with physical, behavioral, long-term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive way possible, while considering the most cost-effective approach.
  • Facilitate authorization, coordination, continuity, and appropriateness of care and services in community or HCBS settings.
  • Facilitate transitions to alternate care settings, such as hospital to home or nursing facility to community setting, using an integrated care team to address members' specific needs.
  • Educate members or caregivers regarding healthcare needs, available benefits, resources, and services, including options for long-term care community or facility-based service delivery.
  • Provide education, resources, and assistance to help members achieve goals outlined in their plan of care and overcome obstacles to achieving optimal care in the least restrictive environment.
  • Develop a plan of care in conjunction with members or caregivers to identify services meeting their specific needs and goals.
  • Identify resources needed for a fully integrated care coordination approach, including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
  • Collaborate with the member's healthcare and service delivery team, including the DSHP Plus LTSS Member Advocate, ICT, and discharge planners, to coordinate care needs and community resources for the member, maintaining them in the least restrictive safe environment possible.
  • Assist members in developing, implementing, and amending a back-up plan for gaps in provider coverage.
  • Ensure approved support services are being provided as outlined in the plan of care.
  • Evaluate the effectiveness of the service plan and make appropriate revisions as needed, in accordance with policy and procedures, and state contractual requirements.
  • Assist members in overcoming obstacles to optimal care through connection with community resources, including communicating with providers and formulating an appropriate action plan.
  • Document all case management services and interventions in the electronic health record.
  • Adhere to all company, state, and federal requirements related to privacy practices, HIPAA, and quality performance standards.
  • Perform other duties as assigned or requested.
Qualifications

Required:

  • Bachelor's degree in Social Work or in health, human, or education services and 3 years of experience in long-term care, home health, hospice, public health, or assisted living OR
  • Master's degree in Social Work or in health, human, or education services and 1 year of experience in long-term care, home health, hospice, public health, or assisted living OR
  • Registered Nurse or Licensed Practical Nurse and 2 years of experience in long-term care, home health, hospice, public health, or assisted living OR
  • A high school degree or equivalent and three years of qualifying experience with case management of the aged, including management of behavioral health conditions, or persons with physical or developmental disabilities, or HIV/AIDS population.

Substitutions:

  • None

Preferred:

  • One year in home clinical or case management experience
  • Certified Case Manager (CCM)
  • Licensed Bachelors Social Worker (LBSW)
  • Licensed Masters Social Worker (LMSW)
  • Licensed Clinical Social Worker (LCSW)
  • Experience working with HIV/AIDS population
  • Experience working with behavioral health population
  • Experience working with developmental disabilities population
  • Medicare and Medicaid experience
  • Managed care experience
Skills
  • Working flexible hours to meet member's needs
  • Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)
  • Reliable transportation daily to be able to travel within assigned territory
  • Ability to meet regulatory deadlines
  • Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies
  • Experience in geriatric special needs, behavioral health, home health
  • Understanding of the importance of cultural competency in addressing targeted populations
  • Experience with electronic documentation system(s)
  • Experience with cost neutrality and budgeting
Language (Other than English):

None

Travel Requirement:

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Works From Home

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

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