Location : 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.
The MyCare Ohio health plan is to deliver high‑quality, trauma‑informed, culturally competent, person‑centered coordination for all members that addresses physical health, behavioral health, long‑term services and supports, and psychosocial needs.
The LTSS Service Coordinator is responsible for managing service coordination for a designated caseload in specialized programs. Collaborate with individuals to lead the Person Centered Planning process, documenting their preferences, needs, and goals. Conduct assessments, create comprehensive Person Centered Support Plans (PCSP), and develop backup plans. Work with Medical Directors and partake in interdisciplinary care rounds to establish a fully integrated care plan. Engage the individual's support network and oversee management of their physical health, behavioral health, and long‑term services and supports, adhering to state and federal regulations.
How you will make an impact
Responsible for performing face‑to‑face program assessments using various tools and pre‑defined questions for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver (such as LTSS/IDD), BH, or PH needs.
Uses tools and pre‑defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high‑risk complications, addresses gaps in care) and coordinates those members’ cases (serving as the single point of contact) with the clinical care‑management and interdisciplinary team in order to provide care coordination support.
Manages non‑clinical needs of members with chronic illnesses, comorbidities, and/or disabilities to ensure cost‑effective and efficient utilization of long‑term services and supports.
At the direction of the member, documents their short and long‑term service and support goals in collaboration with the member’s chosen care team that may include caregivers, family, natural supports, service providers, and physicians. Identifies members that would benefit from an alternative level of service or other waiver programs.
May also serve as mentor, subject matter expert or preceptor for new staff, assisting in formal training of associates, and may be involved in process improvement initiatives.
Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual’s care plan.
Responsible for reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement).
Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits.
Minimum Requirements
BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences
Strong preference for case management experience with older adults or individuals with disabilities.
BA/BS in Health/Nursing preferred.
Job Level: Non‑Management Non‑Exempt
Workshift:
Job Family: MED > Medical Ops & Support (Non‑Licensed)
Elevance Health operates in a hybrid workforce strategy. All new candidates in certain member‑facing roles must be vaccinated against COVID‑19 and Influenza. Elevance Health will follow all relevant federal, state, and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.