UPMC Health Plan is looking for Service Coordinators in the Lehigh Valley 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. To provide service coordination services across the continuum of care through a community-based approach to improve the health outcomes of the Members served.
Service coordination's purpose is for 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. This is a hybrid position that requires traveling into the community on a daily basis.
Establish and build strong relationships with both internal team members and partner providers to foster a collaborative environment. Educates on and coordinates community resources, emphasizing medical, behavioral, and social services. Manages 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. Responsible for performing profession-level administrative duties involving research, analysis, and reporting. Prepare reports regarding service provision and update service plans in accordance with governing bodies.
Ensures comprehensive assessments are completed within required time frames and utilizes 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. Providing information to Members and facilitating access, coordinating, and monitoring LTSS needs for Members. Informing Members about available LTSS, required assessments, the Person t-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 assisting with fair hearing requests when needed and requested, and to protect a Members health, welfare, and quality on an on-going basis.
Collect s 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. Works with the Member to complete activities necessary to maintain LTSS eligibility.
Explores 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 coordinates 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.
Ensures compliance with all state and federal regulations and guidelines in day-to-day activities. Maintain confidentiality and adhere to HIPAA requirements. Willingness and ability to work in the field at least 75% of the time.
Ability to work independently in a virtual setting. Bachelor's degree in social work, psychology, or other related fields with practicum experience preferred OR have 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. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture. Preferred: Minimum year of LTSS, Service Coordination, or Case Management experience.
Additional
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
Minimum speed is 20Mb/s download, 5Mb/s upload less than 50ms ping, and under 10ms jitter