Care Coordinator Specialist
4 weeks ago
We are seeking a skilled Care Coordinator Specialist to join our team at Elevance Health. As a key member of our team, you will be responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs. Your primary goal will be to facilitate the Person Centered Planning process, which involves documenting the member's preferences, needs, and self-identified goals. This will include conducting assessments, developing a comprehensive Person Centered Support Plan (PCSP), and interfacing with Medical Directors and participating in interdisciplinary care rounds to support the development of a fully integrated care plan. Additionally, you will engage the member's circle of support and manage the individual's physical health (PH)/behavioral health (BH)/LTSS needs, as required by applicable state law and contract, and federal requirements.
Key Responsibilities:
- Perform face-to-face program assessments using various tools with pre-defined questions to identify members with potential clinical health care needs.
- Apply motivational interviewing techniques for evaluations, coordination, and management of an individual's waiver (such as LTSS/IDD), and BH or PH needs.
- Use tools and pre-defined identification processes to identify members with potential clinical health care needs and coordinate those member's cases with the clinical healthcare management and interdisciplinary team.
- Manage 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.
- Document short and long-term service and support goals in collaboration with the member's chosen care team.
- Identify members that would benefit from an alternative level of service or other waiver programs.
- May serve as a mentor, subject matter expert, or preceptor for new staff, assisting in the formal training of associates, and may be involved in process improvement initiatives.
- Submit utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.
- Report critical incidents to appropriate internal and external parties, such as state and county agencies (Adult Protective Services, Law Enforcement).
- Assist and participate in appeal or fair hearings, member grievances, appeals, and state audits.
Requirements:
- Requires a 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.
Preferred Skills, Capabilities, and Experiences:
- BA/BS degree field of study in a health care-related field is preferred.
- Specific education, years, and type of experience may be required based upon state law and contract requirements.
- Travels to worksite and other locations as necessary.
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