Medicare Long Term Services & Support Care Coordination

Job Summary

We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Responsibilities

The Medicare LTSS Care Coordinator is responsible for overall management of member's care coordination within the scope of licensure and in accordance with applicable CMS/State and internal requirements. Under the supervision of the Supervisor Medicare LTSS Operations, the Medicare LTSS Care Coordinator must have relevant experience and education to work with members with complex health, behavioral health, long-term services and supports and/or psychosocial needs.

Responsibilities include:

• Provide care coordination to Medicare beneficiaries receiving LTSS and/or custodial care.
• Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long term services and supports.
• Identifies members for high risk complications and coordinates care in conjunction with the member and the Integrated Care Team.
• Care coordination for members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
• Obtains a thorough and accurate member history to develop an individual care plan.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or home and community based waiver programs.
• Responsibility to develop the care plan for services for the member and ensures the member's access to those services.
• Assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate.
• Interfaces with Medical Directors, and other Integrated Care Team participants on the development of care management treatment plans.
• May also assist in problem solving with providers, claims or service issues.
• May direct the work of other licensed and unlicensed professionals in coordinating services for a member by, assigning appropriate tasks, verifying and interpreting member information obtained, conducting additional assessments, as necessary, to develop, monitor, evaluate and revisit the member's care plan to meet the member's needs.
• Maintains a current knowledge of CMS and DHHS requirements along with required licensure and required training.
• Adheres to AmeriHealth Caritas policies and procedures.
• Creates and supports an environment with fosters teamwork, cooperation, respect and diversity.
• Instills work culture of continuous process improvement, innovation and quality.
• Demonstrates and supports commitment to corporate goals and objectives.
• Performs other related duties and projects as assigned.

Education/Experience

Master's Degree. Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW) OR MSW licensure and three (3) years professional practice experience Current, unrestricted licensure. Minimum of 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case management, or similar role; or any combination of education and experience, which would provide an equivalent background.

Other Skills

Proficient PC skills with Microsoft Office Suite (Word, Excel, etc.). Strong knowledge of Medicare/MMP LTSS. Ability to communicate with beneficiaries who have medical needs and may have communication barriers, such as those who may require an interpreter, including sign language, who use assistive technology to communicate. Excellent problem solving and organization skills. Ability to work independently or as a team. Strong interpersonal communication skills. Ability to maintain positive relationship with both internal and external customers. Process Oriented. Attention to detail. Effective time management. Pro-active with ability to multi-task. The ability to closely follow quality standards. Decision making skills. Local travel required (mileage reimbursed). Qualified candidates must live in and be able to travel to BOTH Wayne and Macomb counties in MI. Field experience (home health, etc) preferred.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, competitive pay, paid time off including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement and more. As a company, we support internal diversity through: recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.