Community Health Choices (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. The CHC Assistant Service Coordinator assists in providing service coordination services across the continuum of care through a community-based approach to improve health outcomes of the Participant served.
This role contributes to the LTSS care coordination process by providing telephonic support to Participants and Service Coordinators through a collaborative process to promote quality, cost-effective outcomes. This role helps assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs to include identifying physical health, behavioral health, social services and long-term services and supports.
This entry level coordinator is responsible for outreach activities to Assigned Enrollees in need of complex care management and LTSS CP supports, including but not limited to online research, phone calls, emails, documentation in the electronic platform and complying with all data entry, data integrity, and data tracking requirements. This entry level coordinator is responsible for outreach activities to Assigned Enrollees in need of complex care management and LTSS CP supports, including but not limited to online research, phone calls, emails, documentation in the electronic platform and complying with all data entry, data integrity, and data tracking requirements.
This is a full time position working Monday through Friday daylight hours and will be a remote position, however must reside in Pennsylvania due to geographic hiring requirements.
Establish and build strong relationships with both internal team Participant s and partner provider foster a collaborative environment. Assist Enrollee in navigating and accessing LTSS services or programs and/or eliminating duplication of services. Share with parties who need the Care Plan in connection with their supports of the Participant, including Participant s of the Participant 's care team and other providers who serve the Participant (i.e. state agency or service coordinator assigned to case Collect program data to track participant progress on a monthly basis to ensure to OPS reporting completed per regulatory deadline and that compliance requirements Responsible for performing profession-level administrative duties involving research, analysis and reporting.
Prepare reports regarding service provision and update service plan in accordance with governing bodies. Assist with Service Coordinators and Service Coordinator Associates with escalation issues. Conduct monthly and other calls to participants Research and assist in resolving authorization issues, including securing providers and assisting in obtaining authorizations.
Assist Participant s in obtaining HCBS services that will support independent living Identify, coordinate and assist Participant s 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. Providing information to Participant s and facilitating access, coordinating and monitoring LTSS needs for Participant s.
Informing Participant s 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 to assist with fair hearing requests when needed and requested, and to protect a Participant s health, welfare and quality on on-going basis Collect s additional necessary information, including, at a minimum: Participant preferences, strengths and goals to inform the development of the PCSP Conducts reevaluation of level of care annually or more frequently as needed.
Assist the Participant and his or her PCPT in identifying and choosing willing and qualified Providers. Works with the Participant to complete activities necessary to maintain LTSS eligibility. Explores coverage of services to address Participant identified needs through other sources, including services provided under Medical Assistance, Medicare or private insurance and other community resources.
Actively coordinates with other individuals and entities essential in the physical and behavioral care delivery for the Participant to provide for seamless coordination between physical, behavioral and support services. Ensures compliance with all state and federal regulations and guidelines in day-to-day activities. Maintain confidentiality and adhere to HIPAA requirements.
Performs in accordance with system-wide competencies/behaviors. Performs other duties as assigned. High School Diploma required. 2 years of data entry or customer service experience required.
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. Proficiently and effectively read, write and communicate in English. Additional language capability is preferred.
Communicate in a manner appropriate and respectful to the comprehension level of the consumer and/or family. Cultural competency and the ability to be sensitive to diverse backgrounds and set aside personal opinions and implicit biases. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture.
Highly Preferred Nursing Facility experience Additional language capability is preferred. Proficiently and effectively read, write and communicate in English. Additional language capability is preferred.
Communicate in a manner appropriate and respectful to the comprehension level of the consumer and/or family. Preferred: Minimum of year of LTSS, Service Coordination or Case Management experience. Environmental Conditions: Ability to work independently in virtual setting and make outbound calls.
Physical Demands: Moderate Active, Sitting, Standing and Walking. Internet Speed
Minimum speed is 20Mb/s download, 5Mb/s upload less than 50ms ping, and under 10ms jitter Licensure, Certifications, and Clearances: Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran