LTSS Transition Concierge Coordinator

LTSS Concierge Coordinator (Case Manager)

Hiring statewide across Ohio

This position is primarily remote but may require you to work in the field based on business need up to 10% of the time.

Location : Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

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 an accommodation is granted as required by law.

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 Transition Concierge Coordinator is responsible for supporting the LTSS Transition Coordinator (or contracted provider) in contributing to the components of the person-centered planning process, within Transitions of Care, for individuals enrolled in specialized programs, as required by applicable state law and contract, and federal requirements. Supports in the development, monitoring, and assessment of changes during any transitions of care into the Service Coordination forms and tools, such as the individual's Person-Centered Support Plan (PCSP) in accordance with member's needs. Supports individuals in meeting their established goals, in the setting of their choice, and accessing quality health care services and supports.

How you will make an impact:

• Responsible for performing telephonic and/or virtual outreach to individuals in specialized programs, providers, or other key stakeholders to support the efficacy of the care plan and/or to align with contractual requirements for member outreach, such as coordination and management of an individual's LTSS waiver, behavioral health or physical health needs.

• Responsible for in-person visits, as needed, to accommodate business need.

• Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.

• Utilizes tools and pre-defined identification process, consults with the primary service coordinator to monitor the PCSP, in instances in which a risk is identified related to the members LTSS, physical or behavioral health supports (including, but not limited to, potential for high-risk complications).

• Engages the primary service coordinator and other clinical healthcare management and interdisciplinary teams to provide care coordination support.

• 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.

• 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, 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.

• 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:

• Requires 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 computer skills to include Excel, Outlook and Electronic Medical Records highly preferred.

• BA/BS degree field of study in health care related field preferred.

• Strong preference for case management experience with older adults or individuals with disabilities.

• Specific education, years, and type of experience may be required based upon state law and contract requirements preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also 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 (including gender identity and gender expression), 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 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.