CHC Service Coordinator (Case Management, Social Work) - Lehigh Valley (Hybrid)

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 58,000; Full time

Job summary

UPMC Health Plan is seeking Service Coordinators for the Community HealthChoices program in the Lehigh Valley. This hybrid role requires daily community travel to coordinate LTSS and HCBS services, assess member needs, and guide care planning to promote health outcomes.

As part of a collaborative team, you will manage caseloads, prepare reports, and support members in accessing Medicaid/Medicare benefits and community resources while ensuring compliance with regulations and privacy standards.

Responsibilities

• Establish and build strong relationships with internal team and partner providers to foster a collaborative environment; educate on and coordinate community resources.
• Manage an active caseload per state ratios; collect program data and track participant progress monthly; ensure OPS reporting meets regulatory deadlines.
• Perform professional administrative duties including research, analysis, and reporting; update service plans per governing bodies; ensure timely assessments and assess care options using benefits and community resources.
• Lead the PCSP process and oversee PCSP implementation; assist Members in obtaining HCBS services to support independent living.
• Identify, coordinate, and assist Members in gaining access to LTSS, Medical Assistance, and other services; provide information and coordinate LTSS needs.
• Inform Members about LTSS, required assessments, PCSP, service options including self-direction, DHS Fair Hearing rights, and assist with fair hearings when needed.
• Collect information such as Member preferences, strengths, and goals to inform PCSP; reevaluate level of care; assist in identifying providers.
• Work with Members to maintain LTSS eligibility; explore coverage through MA, Medicare, private insurance, and other community resources.
• Coordinate with professionals to ensure seamless physical, behavioral, and support services; ensure compliance with state/federal regulations and HIPAA.
• Willingness to perform fieldwork 75% of the time and to work independently in a virtual setting.

Job description

UPMC Health Plan is looking for Service Coordinators in the Lehigh Valley to join the Community HealthChoices team!

Community HealthChoices (CHC) is Pennsylvania's managed care long-term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth who are covered by Medicare and Medicaid.

To provide service coordination services across the continuum of care through a community-based approach to improve the health outcomes of the Members served. Service coordination's purpose is for a collaborative process that assesses, plans, implements coordinates, monitors, and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes.

This is a hybrid position that requires traveling into the community on a daily basis.

Responsibilities:

• Establish and build strong relationships with both internal team members and partner providers to foster a collaborative environment. Educates on and coordinates community resources, emphasizing medical, behavioral, and social services.
• Manages an active caseload based on state-mandated ratios according to residential setting, case intensity, and acuity. Collect program data to track participant progress on a monthly basis to ensure that OPS reporting is completed per regulatory deadline and compliance requirements.
• Responsible for performing profession-level administrative duties involving research, analysis, and reporting. Prepare reports regarding service provision and update service plans in accordance with governing bodies. Ensures comprehensive assessments are completed within required time frames and utilizes knowledge and expertise to assess options for care including the use of benefits and community resources.
• Lead the Person-Centered Service Planning (PCSP) process and oversee the implementation of PCSPs. Assist Members in obtaining HCBS services that will support independent living.
• Identify, coordinate, and assist Members in gaining access to needed LTSS and Medical Assistance services, as well as non-Medicaid funded medical, social, housing, educational, and other services and supports. Providing information to Members and facilitating access, coordinating, and monitoring LTSS needs for Members.
• Informing Members about available LTSS, required assessments, the Person t-centered service planning process, service alternatives, service delivery options including opportunities for Self -direction, roles, rights including DHS Fair Hearing rights, risks, and responsibilities, and assisting with fair hearing requests when needed and requested, and to protect a Members health, welfare, and quality on an on-going basis.
• Collect s additional necessary information, including, at a minimum: Member preferences, strengths, and goals to inform the development of the PCSP Conduct reevaluation of the level of care annually or more frequently as needed. Assist the Member and his or her PCPT in identifying and choosing willing and qualified Providers.
• Works with the Member to complete activities necessary to maintain LTSS eligibility. Explores coverage of services to address Member identified needs through other sources, including services provided under Medical Assistance, Medicare or private insurance, and other community resources.
• Actively coordinates with other individuals and entities essential in the physical and behavioral care delivery for the Member to provide for seamless coordination between physical, behavioral, and support services. Ensures compliance with all state and federal regulations and guidelines in day-to-day activities. Maintain confidentiality and adhere to HIPAA requirements.
• Willingness and ability to work in the field at least 75% of the time. Ability to work independently in a virtual setting.