CHC Service Coordinator (Case Management, Social Work)- Erie, PA (Hybrid)

About the role

UPMC Health Plan is looking for Service Coordinators in Erie, PA to join the Community HealthChoices team. Community HealthChoices (CHC) is Pennsylvania's managed care long-term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth who are covered by Medicare and Medicaid. Service coordination's purpose is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes.

Responsibilities

• Establish and build strong relationships with both internal team members and partner providers to foster a collaborative environment.
• Educate on 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 on a monthly basis to ensure that OPS reporting is completed per regulatory deadline and compliance requirements.
• Perform profession-level administrative duties involving research, analysis, and reporting.
• Prepare reports regarding service provision and update service plans in accordance with governing bodies.
• Ensure comprehensive assessments are completed within required time frames and utilize knowledge and expertise to assess options for care including the use of benefits and community resources.
• Lead the Person-Centered Service Planning (PCSP) process and oversee the implementation of PCSPs.
• Assist Members in obtaining HCBS services that will support independent living.
• Identify, coordinate, and assist Members in gaining access to needed LTSS and Medical Assistance services, as well as non-Medicaid funded medical, social, housing, educational, and other services and supports.
• Provide information to Members and facilitate access, coordinate, and monitor LTSS needs for Members.
• Inform Members about available LTSS, required assessments, the Person-Centered Service Planning process, service alternatives, service delivery options including opportunities for Self-direction, roles, rights including DHS Fair Hearing rights, risks, and responsibilities, and assist with fair hearing requests when needed and requested, to protect a Member's health, welfare, and quality on an ongoing basis.
• Collect additional necessary information, including, at a minimum: Member preferences, strengths, and goals to inform the development of the PCSP.
• Conduct reevaluation of the level of care annually or more frequently as needed.
• Assist the Member and his or her PCPT in identifying and choosing willing and qualified Providers.
• Work with the Member to complete activities necessary to maintain LTSS eligibility.
• Explore coverage of services to address Member-identified needs through other sources, including services provided under Medical Assistance, Medicare or private insurance, and other community resources.
• Actively coordinate with other individuals and entities essential in the physical and behavioral care delivery for the Member to provide for seamless coordination between physical, behavioral, and support services.
• Ensure compliance with all state and federal regulations and guidelines in day-to-day activities.
• Maintain confidentiality and adhere to HIPAA requirements.

Requirements

• Bachelor's degree in social work, psychology, or other related fields with practicum experience preferred OR at least three (3) years of experience in a social service or a healthcare-related setting.
• Preferred experience working with people with disabilities or seniors in need of LTSS; and knowledge of the home and community-based service system and how to access and arrange for services.
• Cultural competency and the ability to be sensitive to diverse backgrounds and set aside personal opinions and implicit biases.
• Minimum year of LTSS, Service Coordination, or Case Management experience preferred.
• Must have a valid driver's license.
• Reliable transportation.
• A private workspace free from distractions.
• Ability to meet strict, regulatory deadlines, and willingness to protect confidentiality in accordance with HIPAA guidelines.
• Internet speed requirements: Minimum speed is 20Mb/s download, 5Mb/s upload, less than 50ms ping, and under 10ms jitter.

Licensure, Certifications, and Clearances

• Automotive insurance.
• Driver's license.
• Act 34.