Overview Crystal City, TX Clinical - LTSS Service Care Manager - J01031
Location: Crystal City, Texas. Travel within the Uvalde TX and surrounding areas 3 days a week, days WFH. Shift: 8am-5pm Mon-Fri; overtime may be required. Duration: Temp to Perm. Case load: up to 3 cases per day.
Responsibilities LTSS service care manager will travel 3 days for member visits in their home and work remotely 2 days for documentation of assessments and follow-up tasks.
Assess the member for approval or denial of personal attendant services to assist with activities of daily living by completing a H2060 form in the field.
Fill out required assessments and all forms, document assessments, and submit for authorization or denial of services within a 3 business day turnaround.
Evaluate the needs of the most complex and high-risk members and recommend a plan of care for the best outcome.
Act as liaison and member advocate between the member/family, physician, and facilities/agencies.
Provide and/or facilitate education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication regimens, and healthcare benefits.
Educate on and coordinate community resources, including medical and social services.
Coordinate service authorization for various services based on service assessments and plans (e.g., meals, employment, housing, transportation, activities of daily living).
Ensure appropriate referrals based on individual member needs and support the identification of providers, specialists, and community resources.
Ensure identified services are accessible to members.
Maintain accurate documentation and support the integrity of care management activities in the electronic care management system.
Work to ensure compliance with clinical guidelines and current state and federal guidelines.
Provide feedback to leadership on opportunities to improve quality of care and service delivery for long-term care members in a cost-effective manner. Perform other duties as assigned. Comply with all policies and standards.
Metrics Must meet quality standards of assessments at 92% or above.
Documentation must be completed for assessments within 3 business days.
Required travel of 75%.
Mileage reimbursement provided for member-facing visits.
Qualifications/Requirements LVN/LPN or Care Management experience.
Experience working with aged, blind, or disabled populations (5+ years).
Bilingual strongly preferred (not required).
Tech-savvy (MS Excel, MS Teams, MS Office Suite).
Ability to work in fast-paced environments.
Preferred: Social Work, LVN, or Medical background with at least a bachelor’s degree or 2–4 years of related equivalent experience.
Job Details Seniority level: Mid-Senior level
Employment type: Contract
Job function: Health Care Provider
Industries: Hospitals and Health Care
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