LTSS Service Care Manager

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