LTSS Service Care Manager

Davita Inc.; Raleigh (NC); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking an LTSS Service Care Manager to assist in developing, assessing, and coordinating care management activities. This remote role involves substantial travel and responsibilities including member assessment and coordination of long-term care plans. Candidates should have a Bachelor's degree and at least 2 years of care management experience.

Qualifications

• 2+ years of care management experience required.
• Valid driver's license is mandatory.
• Experience with electronic medical records preferred.

Responsibilities

• Develops and coordinates care plans for long-term care members.
• Monitors care plans and member statuses.
• Provides education to members on healthcare services.

Skills

Care management

Coordination of services

Assessment skills

Member support

Documentation

Education

Bachelor's degree in Healthcare related field

Tools

Electronic medical health records

TruCare software

Job description

Position Title: LTSS Service Care Manager

Work Location: Remote (Region 4, Duval county)

Assignment Duration: 3 months with intent to convert

Work Schedule: 8-5 Mon-Fri,

Work Arrangement: Remote role with 80% travel, requiring a driver's license

Position Summary:

• Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes.


• May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.

Background & Context:

• Health plan: Sunshine State Health Plan


• The team has strong longevity, and many team members have been part of the team for years.


• This role is remote but also requires fieldwork, which allows for a self-made independent role.


• They can build and schedule their meetings throughout the week.

Key Responsibilities:

• Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome.


• Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care.


• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members.


• Provides resource support to members and their families/caregivers for various needs (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans.


• Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs.


• Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met.


• Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.


• May perform home and/or other site visits to assess member's needs and collaborate with healthcare providers and partners.


• Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits.


• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.


• Performs other duties as assigned.


• Complies with all policies and standards.


• Managing a caseload for healthcare members with long-term care needs.


• Geriatric long-term care.


• Member assessments and notes.


• Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development.


• Monitor delivery of services and follow-up with members, caregivers, or providers through in-person visits and telephonic contact.


• Authorize and coordinate referral for services.


• Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care.


• Assist in coordinating the development of informal or voluntary services to integrate into the member care plan.


• Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care services.


• Assist member with filing and resolving complaints and appeals.

Qualification & Experience:

• Requires a Bachelor's degree and 2-4 years of related experience.


• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope, and skill reflective of the level of this position.


• Valid driver's license required.


• 2+ years of care management experience (field experience is a must).


• Caseloads of 50, 60, 70 members - bonus if geriatric.


• Long-term care Medicaid experience.


• Medicaid/Medicare experience.


• Experience being able to manage high caseloads.


• Fast-paced environment regarding new processes and programs.


• Comfortable connecting with IT should equipment fail in the field or able to go into an office location or IT space.


• All documentation must be within system within 24 hours of completion.


• Experience with electronic medical health records.


• Home health experience.


• Preferred: Discharge planning, working with TruCare software.


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  Candidate Requirements
  Education/Certification	Required: Requires a Bachelor's degree and 2 - 4 years of related experience. (Bachelors Degree should be within the realm of Healthcare) - Psychology, Sociology, etc. Field experience would need to be long term to have the team consider someone that does not have a degree within the space they are looking for.	Preferred: n/a
  Licensure	Required: Valid driver's license	Preferred: n/a