LTSS Service Care Manager

Position Title : LTSS Service Care Manager
Work Location : Spanish-speaking (Pembroke Pines, Miramar, Hallandale, Weston, Dania, or Davie areas)
Also, zip codes to source from: 33004, 33019, 33020, 33021, 33022, 33023, 33024, 33025, 33026, 33027, 33028, 33029, 33312, 33314, 33317, 33324, 33325, 33328, 33330, 33331, 33326, 33327, 33331
Assignment Duration : 3 months (Contact to hire)
Work Schedule : Monday - Friday, 8 am - 5 pm
Work Arrangement : Field-based (80% travel expected); remote role requiring a driver's license; candidates must reside in the specified Broward area

Position Purpose:
Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalised service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs

Key Responsibilities:
* Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
* Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialists, and/or community resources needed for long-term care
* Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members
* Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans
* Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
* Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met
* Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations
* May perform home and/or other site visits to assess member's needs and collaborate with healthcare providers and partners
* Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
* Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
* Performs other duties as assigned
* Complies with all policies and standards
* Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development
* Monitor delivery of services and follow up with members, caregivers, or providers through in-person visits and telephonic contact
* Authorise and coordinate referral for services
* Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care
* Assist in coordinating the development of informal or voluntary services to integrate into the member care plan
* Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care services
* Assist member with filing and resolving complaints and appeals

Candidate Requirements Education/Certification Required: Requires a Bachelor's degree and 2 - 4 years of related experience Preferred: Licensure Required: i.e. RN, BSN, LPN, etc. Preferred:

• Years of experience required
• Disqualifiers
• Best vs. average
• Performance indicators

Must haves:

• 2+ years of Care Management experience (field experience is a must)
• Home Health Experience
• Long Term Care Medicaid experience
• Medicaid / Medicare experience
• Need to see experience being able to manage high case load - Caseloads of 50,60,70 members who are 65 years of age and above team is not looking for pediatric experience
• Experience with electronic medical health records

Nice to haves:

• Team has noticed that people that perform well in this role are those that have case management experience
• Field based experience with managing a caseload similar to the one noted for this team (60-120 members)
• Individuals with previous DFPS experience

Disqualifiers:

• Having telephonic customer service calls is not what the team is seeking in regard to case management. They are really seeking someone with in the field case management experience
• Not having field experience
• Not having previous experience with high caseloads
• Not at least meeting 40 WPM on typing test

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1 2+ years of Care Management experience (field experience is a must)
2 Home Health Experience 3 Experience with electronic medical health records