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Bilingual LTSS Care Coordinator

2 months ago

Miami, United States Elevance Health Full time

Position Overview:

Title:
Bilingual LTSS Service Coordinator

Job Summary:
The Bilingual LTSS Service Coordinator is primarily a field-based role, requiring the candidate to work remotely while engaging directly with patients and healthcare providers. This position necessitates travel to various locations as needed.

The coordinator is tasked with executing service coordination duties for a designated group of individuals enrolled in specialized programs.

In partnership with the individuals served, the coordinator will facilitate the Person-Centered Planning process, which captures the member's preferences, needs, and self-identified objectives. This includes conducting assessments, creating a comprehensive Person-Centered Support Plan (PCSP), and developing backup plans. The coordinator will also interface with Medical Directors and take part in interdisciplinary care rounds to aid in crafting a fully integrated care plan, while involving the member's support network and managing their physical health (PH), behavioral health (BH), and LTSS requirements, in accordance with state and federal regulations.


Key Responsibilities:

Conduct face-to-face program assessments utilizing various tools with established questions to identify needs, applying motivational interviewing techniques for evaluations, and managing the individual's waiver (such as LTSS/IDD) alongside their BH or PH requirements.

Employ identification tools and predefined processes to recognize members with potential clinical healthcare needs, including those at risk for high complications, and coordinate their cases as the primary contact with the clinical healthcare management and interdisciplinary team to ensure effective care coordination.

Oversee the non-clinical needs of members with chronic conditions, co-morbidities, and/or disabilities, ensuring the efficient and cost-effective use of long-term services and supports.

At the member's direction, document their short- and long-term service and support goals in collaboration with their chosen care team, which may include caregivers, family members, natural supports, service providers, and healthcare professionals.

Identify members who may benefit from alternative service levels or other waiver programs.

May also act as a mentor, subject matter expert, or preceptor for new team members, assisting in the formal training of associates and participating in process improvement initiatives.

Submit utilization and authorization requests to management with supporting documentation that aligns with the individual's care plan.

Responsible for reporting critical incidents to relevant internal and external parties, including state and county agencies (such as Adult Protective Services and Law Enforcement). Assist and engage in appeals, member grievances, and state audits.


Qualifications:


A BA/BS degree is required, along with a minimum of 2 years of experience in a social work agency, or a combination of education and experience that provides a comparable background.

Specific educational requirements and experience may vary based on state law and contract stipulations.

Preferred Skills and Experience:
A BA/BS degree in a healthcare-related field is preferred.
Bilingual proficiency in English and Spanish is strongly preferred.

Job Level:
Non-Management Non-Exempt

Work Shift:
1st Shift (United States of America)

Job Family:

MED > Medical Operations & Support (Non-Licensed)
Elevance Health is committed to improving lives and communities by simplifying healthcare. We are a Fortune 25 company with a rich history in the healthcare sector, seeking leaders at all levels who are dedicated to making a positive impact on our members and the communities we serve.

At Elevance Health, we are fostering a culture designed to advance our strategy while promoting personal and professional growth for our associates. Our values and behaviors are fundamental to our culture, driving our strategy, business outcomes, and shared success for our consumers, associates, communities, and business.

We offer a competitive range of total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), as well as medical, dental, vision, short and long-term disability benefits, 401(k) with matching, stock purchase plans, life insurance, wellness programs, and financial education resources.

Elevance Health operates under a Hybrid Workforce Strategy. Unless specified as primarily virtual, associates are expected to work at an Elevance Health location at least once a week, with specific requirements discussed during the hiring process. Candidates must reside within a reasonable commuting distance of an Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to be vaccinated against COVID-19, with exceptions considered based on acceptable explanations. Elevance Health adheres to all relevant federal, state, and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable laws.