LTSS Service Care Manager

Position Title: LTSS Service Care Manager

Work Location: Member facing - NC, Region 2, EST zone

Assignment Duration: 5 Months Contract to Hire

Work Schedule: 8 am-5 pm EST Monday - Friday (No OT)

Work Arrangement: Primarily remote with required face-to-face home visits with members; occasional in-person team meetings; potential for >50% travel within the region

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

Background & Context: This role supports The Organization's health plan members in North Carolina Region 2 who have complex medical needs. The team works alongside utilization management, quality, transition of care, care managers, coordinators, and navigators to deliver coordinated care across the continuum. Additional LTSS care management coverage is needed due to current caseload volume and business fluctuations in Region 2 counties.

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, specialist, 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 regulators
• 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

Qualification & Experience: