LTSS Transition Concierge Coordinator

2 weeks ago

Salem, Connecticut, United States Elevance Health Full time
Job Summary:

The LTSS Transition Concierge Coordinator is responsible for supporting the LTSS Coordinator (or contracted provider) in completing components of the person-centered planning process, within Transitions of Care, for individuals enrolled in specialized programs, as required by applicable state law and contract, and federal requirements.

Key Responsibilities:

Performs telephonic and/or virtual outreach to individuals in specialized programs, providers, or other key stakeholders involved in any transitions of care of members, to support the efficacy of the care plan and/or to align with contractual requirements for member outreach, such as coordination and management of an individual's waiver (such as LTSS/IDD), behavioral health or physical health needs.
Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.
Using tools and pre-defined identification process, consults with the primary service coordinator to monitor the PCSP, in instances in which a risk is identified related to the members LTSS, physical or behavioral health supports (including, but not limited to, potential for high-risk complications).
Engages the primary service coordinator and other clinical healthcare management and interdisciplinary teams to provide transitions of care coordination support.
Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports.
At the direction of the member, documents their short- and long-term service and support goals in collaboration with the member's chosen care team that may include, caregivers, family, natural supports, and physicians. Identifies members that would benefit from an alternative level of service or other waiver programs.
May also serve as mentor, subject matter expert or preceptor for new staff, assisting in formal training of associates and may be involved in process improvement initiatives.
Responsible for reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement).
Assists and participates in appeal or fair hearings, member grievances, appeals and state audits.

Requirements:

Requires BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background.
BA/BS degree field of study in health care related field preferred.
Specific education, years, and type of experience may be required based upon state law and contract requirements.
Current unrestricted RN license in applicable state(s) preferred

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