LTSS Administration Services Coordinator - Lead

Elevance Health • Tampa, FL

18h • Hybrid

About The Position

LTSS Administration Service Coordinator - Lead Field and in office. Location: Florida. Lake Mary, Miami, Tampa. Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Simply Healthcare Plans, Inc. is a proud member of the Elevance Health family of companies. We are a health maintenance organization with health plans for people enrolled in Medicaid and/or Medicare programs. We’re working to help make health care simple, so members can focus on what matters most. The LTSS Administration Service Coordinator - Lead is responsible for assisting management with day-to-day activities, such as monitoring and prioritizing workflow. Will perform reviews to ensure forms are completed accurately and timely. Assists in the development and maintenance of policies and procedures, training materials and job resources. Leads projects and participates in workgroups with cross-functional teams and serves as a representative on business unit and enterprise initiatives. Performs process evaluations and tests and monitors systems/process enhancements. How you will make an impact: Responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract; develops, monitors, and revises the member's service plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's long-term service and support needs. Using tools and a pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high-risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support. The process does not involve clinical judgment. Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost-effective and efficient utilization of long-term services and supports. Establishes short and long-term service and support goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of service or other waiver programs. May also serve as a mentor or preceptor for new staff, assisting in the formal training of associates and may be involved in process improvement initiatives.

Requirements

• Requires a BA/BS degree and a minimum of 2 years of experience working with a social work agency as well as a minimum of 5 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator or similar role; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• BA/BS degree field of study in healthcare related field preferred.
• Specific education and years and type of experience may be required based upon state law and contract requirements.
• Travels to worksite and other locations as necessary.

Responsibilities

• Responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract
• Develops, monitors, and revises the member's service plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.
• Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's long-term service and support needs.
• Using tools and a pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high-risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support. The process does not involve clinical judgment.
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost-effective and efficient utilization of long-term services and supports.
• Establishes short and long-term service and support goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of service or other waiver programs.
• May also serve as a mentor or preceptor for new staff, assisting in the formal training of associates and may be involved in process improvement initiatives.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level