LTSS Care Manager

Position Title: LTSS Care Manager

Work Location: Lee County, Ft Myers, Florida

Assignment Duration: 3 months

Work Schedule: 8-5 Mon-Fri

Work Arrangement: Remote role with 80% travel, requires valid driver's license

Bilingual (Spanish) required for Region 8

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:

• 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 requires field work, allowing for a self-made independent role
• Candidates 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
• 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
• For Iowa Only: Bachelor's degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least two years of experience in the delivery of services to the population groups or current state's Registered Nurse (RN) license and at least four years of experience required
• For North Carolina Standard Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services. RN or LCSW required
• For North Carolina Tailored Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services. RN or LCSW / LCSW-A preferred
• Must haves:
  
  
  
  • 2+ years of Care Management experience (field experience is a must)
  • Caseloads of 50,60,70 members - bonus if it is geriatric
  • Long Term Care Medicaid experience
  • Medicaid / Medicare experience
  • Need to see experience being able to manage high case load
  • Fast-paced environment regarding new processes and programs
  • They must be comfortable being able to connect with IT should their equipment fail in the field, etc. or be 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
  
  
  
  
• Nice to haves:
  
  
  
  • Discharge Planning
  • Working with TruCare which is the software the team uses
  
  
  
  
• Disqualifiers:
  
  
  
  • Not having field experience
  • Not having previous experience with high caseloads
  
  
  
  
• Valid driver's license required