LTSS Service Coordinator – Case Manager

Jobtailor; Sebring (FL); On-site; USD 42,000 - 64,000; Full time

Job summary

Jobtailor seeks a skilled Care Coordination Specialist to manage a defined caseload within specialized programs. You will coordinate assessments, document Person Centered Plans, and maintain close collaboration with medical directors and an interdisciplinary team to create integrated care strategies in alignment with member goals.

Required BA/BS and at least two years in social work or LTSS settings; English/Spanish bilingual preferred.

Qualifications

• Requires BA/BS degree.
• Minimum 2 years of experience with a social work agency.
• Any combination of education and experience providing equivalent background.
• Specific education, years, and type of experience may be required under state law.
• Bilingual in English/Spanish strongly preferred.
• LTSS, case management, social work or hospital discharge planning experience preferred.

Responsibilities

• Conduct service coordination for a defined caseload.
• Facilitate Person Centered Planning documenting member goals and preferences.
• Conduct assessments and develop a comprehensive PCSP and backup plan.
• Interface with Medical Directors and participate in interdisciplinary care rounds to support an integrated care plan.
• Engage the member’s circle of support and manage physical/behavioral health and LTSS needs.
• Perform face-to-face program assessments for identification.
• Apply motivational interviewing techniques for evaluations and coordination.
• Coordinate cases with clinical health care management and interdisciplinary team.
• Manage non-clinical needs of members with chronic illnesses or disabilities.
• Assist in appeals, grievances, state audits, and fair hearings.

Skills

Person Centered Planning

Case Management

Motivational Interviewing

Interdisciplinary Team Collaboration

Bilingual English/Spanish

Education

BA/BS Degree

Job description

• Responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs
• In collaboration with the person supported, facilitates the Person Centered Planning process that documents the member’s preferences, needs and self-identified goals
• conducting assessments, development of a comprehensive Person Centered Support Plan (PCSP) and backup plan
• interfacing with Medical Directors and participating in interdisciplinary care rounds to support development of a fully integrated care plan
• engaging the member’s circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs
• Responsible for performing face to face program assessments for identification
• applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver
• Uses tools and pre-defined identification process, identifies members with potential clinical health care needs
• coordinates those member’s cases with the clinical healthcare management and interdisciplinary team
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities
• Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits

Requirements

• Requires BA/BS degree
• a minimum of 2 years of experience working with a social work agency
• any combination of education and experience which would provide an equivalent background
• Specific education, years, and type of experience may be required based upon state law and contract requirements
• Bilingual in English/ Spanish strongly preferred
• LTSS, case management, social work or hospital discharge planning experience preferred

Core Competencies

Demonstrates expertise in conducting assessments and developing comprehensive Person Centered Support Plans (PCSP) while effectively coordinating care for individuals with physical and behavioral health needs. Proficient in applying motivational interviewing techniques and managing interdisciplinary team collaboration.

Highest-signal resume keywords

• Person Centered Planning
• Case Management
• Motivational Interviewing
• Interdisciplinary Team Collaboration
• Bilingual in English/Spanish

ATS Optimization Keywords

Hard Skills

• Assessment Development
• Person Centered Support Plan (PCSP)
• Clinical Health Care Needs Identification
• Chronic Illness Management
• Social Work Experience
• LTSS Experience
• Hospital Discharge Planning

Soft Skills

• Communication
• Collaboration
• Problem Solving

Certifications & Qualifications

• BA/BS Degree

Industry Keywords

• Social Work Agency
• Member Grievances
• State Audits
• Fair Hearings