CHC Nursing Facility Service Coordination- Chester & Lancaster Counties- Hy

at  UPMC

UPMC Health Plan has an exciting opportunity for a Nursing Facility Service Coordinator position for Community HealthChoices. This is a full-time position working daylight hours and will be a hybrid position. This position will be based in Chester and Lancaster County. Some travel will be required.
To provide service coordination services across the continuum of care through a community-based approach to improve health outcomes of the Members served. Service coordination’s purpose is a 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.

• Establish and build strong relationships with both internal team members and partner provider foster a collaborative environment.
• Educates on and coordinates community resources with emphasis on 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 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.
• Ensures comprehensive assessments are completed within required time frames and utilizes knowledge and expertise to assess options for care including use of benefits and community resources.
• Lead the Person-Centered Service Planning (PCSP) process and oversee the implementation of PCSPs.
• Assist Members in obtaining services that will support them while living in a Nursing Facility.
• 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 to assist with fair hearing requests when needed and requested, and to protect a Members health, welfare and quality on on-going basis.
• Collect s additional necessary information, including, at a minimum: Member 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 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 virtual setting.
• Service Coordinators must have a 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 of year of LTSS, Service Coordination or Case Management experience.Licensure, Certifications, and Clearances:
• Driver’s License
• Act 34