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Long-term Care Coordinator
2 months ago
Company :
Highmark Inc.
Position Overview :
JOB SUMMARY
This role acts as the primary liaison for members, ensuring comprehensive coordination of their care requirements across various service delivery systems and community resources. This is a full-time position that necessitates regular travel within the designated area.
KEY RESPONSIBILITIES
- Conduct in-person assessments at members' residences, nursing homes, and other community locations, followed by ongoing telephonic communication to align with state and national guidelines.
- Evaluate, plan, coordinate, implement, and assess care for eligible members facing chronic and complex health care, social service, and custodial challenges.
- Facilitate care coordination across a spectrum of services, addressing members' physical, behavioral, and psychosocial needs in a safe and cost-effective manner.
- Manage authorizations and ensure continuity and appropriateness of care in community settings.
- Support transitions between care environments, such as from hospital to home, utilizing an integrated care team to meet specific member needs.
- Provide education to members and caregivers regarding health care options, available benefits, and resources.
- Assist members in achieving their care goals as outlined in their care plans while overcoming barriers to optimal care.
- Collaborate with members and caregivers to create tailored care plans that address specific needs and objectives.
- Identify necessary resources for a holistic care coordination approach, including referrals to specialized programs.
- Work alongside the member's healthcare team to ensure effective coordination of care and community resources.
- Help members develop and maintain backup plans for any gaps in provider coverage.
- Ensure that approved support services are delivered as per the care plan.
- Regularly assess the effectiveness of service plans and make necessary adjustments in line with policies and contractual obligations.
- Assist members in navigating community resources to enhance their care experience.
- Maintain accurate documentation of all case management services in the electronic health record.
- Comply with all company, state, and federal regulations regarding privacy practices and quality standards.
- Perform additional duties as assigned.
QUALIFICATIONS
Required
- Bachelor's degree in Social Work or related field with three years of experience in long-term care, home health, or similar settings OR
- Master's degree in Social Work or related field with one year of relevant experience OR
- Registered Nurse or Licensed Practical Nurse with two years of experience in relevant care settings OR
- High school diploma or equivalent with three years of experience in case management for aged populations or individuals with disabilities.
Preferred
- Experience in home clinical or case management roles.
- Certification as a Case Manager (CCM).
- Licensure as a Bachelors or Masters Social Worker.
- Experience with populations affected by HIV/AIDS or behavioral health issues.
- Familiarity with Medicare and Medicaid systems.
- Background in managed care environments.
SKILLS
- Flexibility in working hours to accommodate member needs.
- Proficiency in word processing and database documentation.
- Reliable transportation for travel within the assigned area.
- Ability to meet regulatory deadlines.
- Experience in geriatric care and understanding of cultural competency.
- Familiarity with electronic documentation systems.
- Knowledge of budgeting and cost neutrality.
Travel Requirement:
25% - 50%
WORKING CONDITIONS
This position requires working from home, with occasional travel to various sites. Physical demands include lifting up to 25 pounds occasionally.
Disclaimer: This job description is intended to provide a general overview of the position and does not encompass all duties and responsibilities.
Compliance Requirement: Adherence to ethical and legal standards as outlined in company policies is mandatory.
Pay Range:
Minimum: $57,700.00 - Maximum: $106,700.00
Highmark Health is an equal opportunity employer, committed to diversity and inclusion in the workplace.
