CHC Service Coordinator Nursing Facility- Lackawanna and Wayne Counties- Hybrid

UPMC; Pittsburgh (Allegheny County); Remote; USD 45,000 - 60,000; Full time

Job summary

A healthcare provider is seeking a full-time CHC Service Coordinator for Nursing Facilities to support community health initiatives. This remote role requires significant travel and focuses on improving health outcomes for participants. Candidates should have a Bachelor's degree in social work or related fields, with experience in social services, and must be culturally competent. A valid driver's license and reliable transportation are necessary.

Qualifications

• Experience working in social service or healthcare settings.
• Understanding of LTSS and community-based service systems required.
• Sensitivity to diverse cultural backgrounds.

Responsibilities

• Coordinate and educate on community resources for Members.
• Manage caseload and track participant progress monthly.
• Complete assessments and service plans timely.

Skills

Cultural competency

Strong communication

Problem-solving

Relationship building

Education

Bachelor's degree in social work, psychology, or related field

Job description

UPMC Health Plan is seeking a full-time CHC Service Coordinator, Nursing Facility to support Community HealthChoices in Lackawanna & Wayne Counties.

UPMC Community HealthChoices (CHC) is a managed care plan that provides coverage for medical care and long-term services and supports (LTSS) for eligible individuals who qualify for Medical Assistance. CHC is also for individuals who qualify for Medicare, Medicaid, or require a nursing facility level of care.

The CHC Service Coordinator, Nursing Facilities will work daylight hours, Monday through Friday, in a remote capacity, supporting participants across Lackawanna and Wayne County, and will require significant travel to multiple nursing facilities. This role provides service coordination services across the continuum of care through a community-based approach to improve health outcomes of the Members served.

The Nursing Facilities CHC Service Coordinator helps the most vulnerable individuals in a nursing facility setting. For individuals preferring to return to the community, this role supports steps to ensure that the transition will be safe and successful. For those wishing to remain in the nursing facilities, the CHC Service Coordinator will help ensure that needs are met and that individuals are receiving quality care.

Responsibilities:

• Establish and build strong relationships with both internal team members and partner providers to foster a collaborative environment, educating on and coordinating community resources with emphasis on medical, behavioral, and social services.
• Manage 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 OPS reporting is completed per regulatory deadline and that compliance requirements are met.
• Perform profession-level administrative duties involving research, analysis, and reporting. Prepare reports regarding service provision and update service plans in accordance with governing bodies. Ensure comprehensive assessments are completed within required time frames and utilize knowledge and expertise to assess options for care, including use of benefits and community resources.
• Lead the Person-Centered Service Planning (PCSP) process and oversee the implementation of PCSPs. Assist Members in obtaining services that will support them while living in a Nursing Facility.
• 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.
• Inform Members about available LTSS, required assessments, the Person-Centered service planning process, service alternatives, service delivery options, including opportunities for Self-direction, roles, rights, including DHS Fair Hearing rights, risks, and responsibilities.
• Collect additional necessary information, including Member preferences, strengths, and goals to inform the development of the PCSP. Conduct reevaluation of level of care annually or more frequently as needed.
• Work with the Member to complete activities necessary to maintain LTSS eligibility. Explore 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 coordinate with other individuals and entities essential in the physical and behavioral care delivery for the Member to provide seamless coordination between physical, behavioral, and support services. Ensure compliance with all state and federal regulations and guidelines in day-to-day activities.
• Willingness and ability to work in the field at least 75% of the time. Ability to work independently in a virtual setting.

Requirements:

• Bachelor's degree in social work, psychology, or other related fields with practicum experience preferred, or at least three years of experience in a social service or healthcare-related setting.
• Preferred experience working with people with disabilities or seniors in need of LTSS, and knowledge of the home and community-based service system and how to access and arrange for services.
• Cultural competency and the ability to be sensitive to diverse backgrounds and set aside personal opinions and implicit biases.

Preferred:

• Minimum of one year of LTSS, Service Coordination, or Case Management experience.

Additional Requirements:

• Valid driver's license
• Reliable transportation
• Clean driving record
• A private workspace free from distractions
• Ability to meet strict, regulatory deadlines, and willingness to protect confidentiality in accordance with HIPAA guidelines

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran.