Job Description

UPMC Health Plan is seeking a full-time CHC Service Coordinator, Nursing Facility to support Community HealthChoices in Lackawanna & Wayne Counties!

UPMC Community HealthChoices (CHC) is a managed care plan that is available in all Pennsylvania counties that provides coverage for medical care and long-term services and supports (LTSS) for eligible individuals who qualify for Medical Assistance! Additionally, CHC is also for individuals that qualify for Medicare, Medicaid, or require a nursing facility level of care. 

The CHC Service Coordinator, Nursing Facilities will work daylight hours, Monday through Friday, in a remote capacity! This role will support participants across Lackawanna and Wayne County and will require significant travel to multiple nursing facilities. The CHC Service Coordinator provides service coordination services across the continuum of care through a community-based approach to improve health outcomes of the Members served. This role fosters a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes. 

The Nursing Facilities CHC Service Coordinator specifically helps the most vulnerable individuals in a nursing facility setting. For individuals preferring to return to the community, this role supports steps to ensure that the transition will be safe and successful. For those wishing to remain in the nursing facilities, the CHC Service Coordinator will help ensure that needs are met and that individuals are receiving quality care.

Responsibilities:

• Establish and build strong relationships with both internal team members and partner provider foster a collaborative environment. Educates on and coordinates community resources with emphasis on medical, behavioral and social services.
• Manages an active caseload based on state mandated ratios according to residential setting, case intensity and acuity. Collect program data to track participant progress on a monthly basis to ensure to OPS reporting completed per regulatory deadline and that compliance requirements.
• Responsible for performing profession-level administrative duties involving research, analysis and reporting. Prepare reports regarding service provision and update service plan in accordance with governing bodies. Ensures comprehensive assessments are completed within required time frames and utilizes knowledge and expertise to assess options for care including use of benefits and community resources.
• Lead the Person-Centered Service Planning (PCSP) process and oversee the implementation of PCSPs. Assist Members in obtaining services that will support them while living in a Nursing Facility.
• Identify, coordinate and assist Members in gaining access to needed LTSS and Medical Assistance services, as well as non-Medicaid funded medical, social, housing, educational, and other services and supports. Providing information to Members and facilitating access, coordinating and monitoring LTSS needs for Members.
• Informing Members about available LTSS, required assessments, the Person t-centered service planning process, service alternatives, service delivery options including opportunities for Self -direction, roles, rights including DHS Fair Hearing rights, risks and responsibilities, and to assist with fair hearing requests when needed and requested, and to protect a Members health, welfare and quality on on-going basis.
• Collect s additional necessary information, including, at a minimum: Member preferences, strengths and goals to inform the development of the PCSP Conducts reevaluation of level of care annually or more frequently as needed. Assist the Member and his or her PCPT in identifying and choosing willing and qualified Providers.
• Works with the Member to complete activities necessary to maintain LTSS eligibility. Explores coverage of services to address Member identified needs through other sources, including services provided under Medical Assistance , Medicare or private insurance and other community resources.
• Actively coordinates with other individuals and entities essential in the physical and behavioral care delivery for the Member to provide for seamless coordination between physical, behavioral and support services. Ensures compliance with all state and federal regulations and guidelines in day-to-day activities. Maintain confidentiality and adhere to HIPAA requirements.
• Willingness and ability to work in the field at least 75% of the time. Ability to work independently in virtual setting.

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