CHC Service Coordinator (Care Management, Home & Community Based)- Allentown, PA (Hybrid)

UPMC Health Plan is seeking Service Coordinators in Allentown, PA for the Community HealthChoices team. This hybrid position requires daily travel into the community. Community HealthChoices (CHC) is Pennsylvania's managed care long-term services and supports (LTSS) program serving seniors and individuals with physical disabilities covered by Medicare and Medicaid.

About the Role

The Service Coordinator will provide service coordination through a community-based approach to improve health outcomes for Members. This involves a collaborative process assessing, planning, implementing, coordinating, monitoring, and evaluating services to meet individuals' health needs, promoting quality, cost-effective outcomes.

We seek candidates with a strong background in case management and care coordination, experience conducting in-home assessments, and the ability to work with adult populations who have complex medical, behavioral, and social needs. The ideal candidate is compassionate, resourceful, and committed to helping participants remain safely and independently in their homes and communities.

Responsibilities

• Establish and build strong relationships with internal team members and partner providers to foster collaboration.
• Educate and coordinate community resources, emphasizing 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 monthly, ensuring OPS reporting is completed per regulatory deadlines.
• Perform profession-level administrative duties involving research, analysis, and reporting.
• Prepare reports regarding service provision and update service plans in accordance with governing bodies.
• Complete comprehensive assessments within required time frames and assess care options, including benefits and community resources.
• Lead the Person-Centered Service Planning (PCSP) process and oversee PCSP implementation.
• Assist Members in obtaining Home and Community-Based Services (HCBS) to support independent living.
• Identify, coordinate, and assist Members in accessing LTSS, Medical Assistance services, and non-Medicaid funded supports (e.g., medical, social, housing, educational).
• Provide information to Members about available LTSS, assessments, service alternatives, self-direction opportunities, roles, rights (including DHS Fair Hearing rights), risks, and responsibilities.
• Assist with fair hearing requests and protect Members' health, welfare, and quality of life on an ongoing basis.
• Collect Member preferences, strengths, and goals to inform PCSP development.
• Conduct reevaluation of the level of care annually or as needed.
• Assist Members and their Person-Centered Planning Team (PCPT) in identifying and choosing willing and qualified Providers.
• Complete activities necessary to maintain LTSS eligibility with the Member.
• Explore coverage of services through Medical Assistance, Medicare, private insurance, and community resources.
• Coordinate with individuals and entities essential for seamless physical, behavioral, and support service delivery.
• Ensure compliance with all state and federal regulations and guidelines.
• Maintain confidentiality and adhere to HIPAA requirements.
• Work in the field at least 75% of the time and independently in a virtual setting.

Requirements

• Bachelor’s degree in social work, psychology, or a related field with practicum experience OR at least three (3) 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 home and community-based service systems.
• Cultural competency and sensitivity to diverse backgrounds, including principles, values, ethics, and customs.
• Preferred: Minimum one year of LTSS, Service Coordination, or Case Management experience.
• Valid driver’s license and reliable transportation.
• Private workspace free from distractions.
• Ability to meet strict regulatory deadlines and protect confidentiality per HIPAA guidelines.

Additional Information

Internet speed requirements: Minimum 20Mb/s download, 5Mb/s upload, less than 50ms ping, and under 10ms jitter.