LTSS Service Coordinator (Case Manager) Eastern Ohio

About the role

The MyCare Ohio health plan delivers high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The LTSS Service Coordinator is responsible for managing service coordination for a designated caseload in specialized programs. Collaborate with individuals to lead the Person Centered Planning process, documenting their preferences, needs, and goals. Conduct assessments, create comprehensive Person Centered Support Plans (PCSP), and develop backup plans. Work with Medical Directors and partake in interdisciplinary care rounds to establish a fully integrated care plan. Engage the individual's support network and oversee management of their physical health, behavioral health, and long-term services and supports, adhering to state and federal regulations.

Responsibilities

• Perform face to face program assessments (using various tools with pre-defined questions) for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual's waiver (such as LTSS/IDD), and BH or PH needs.
• Use tools and pre-defined identification process to identify members with potential clinical health care needs (including, but not limited to, potential for high-risk complications, addresses gaps in care) and coordinate those member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team to provide care coordination support.
• Manage non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports.
• At the direction of the member, document their short and long-term service and support goals in collaboration with the member's chosen care team that may include caregivers, family, natural supports, service providers, and physicians.
• Identify members that would benefit from an alternative level of service or other waiver programs.
• May serve as mentor, subject matter expert or preceptor for new staff, assisting in the formal training of associates, and may be involved in process improvement initiatives.
• Submit utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.
• Report critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement).
• Assist and participate in appeal or fair hearings, member grievances, appeals, and state audits.

Requirements

• BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background.

Preferred qualifications

• Case management experience with older adults or individuals with disabilities.
• BA/BS in Health/Nursing.

Location

This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. Candidates must live in one of the following Ohio counties: Cuyahoga, Franklin, Geauga, Huron, Lake, Lorain, Medina, Monroe, Noble, Richland, Washington, Tuscarawas, Carroll, Harrison, Crawford, Seneca, Marion, Coshocton, or Stark. Alternate locations may be considered if candidates reside within a commuting distance from an office. Per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Pay

For candidates working in person or virtually in Columbus, OH, the salary range for this position is $26.19/hr to $39.29/hr.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

All benefits are subject to eligibility requirements.