Medicare Care Coordinator - Long Term Services & Support (LTSS) - Western Wayne County, Michigan

Your career starts now. We’re looking for the reputed company of reputed company leaders. At reputed company, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in reputed company solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. reputed company is seeking talented, passionate individuals to join reputed company. Together, we can build healthier communities. If you want to reputed company a difference, we’d like to hear from you. Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. ; About this job: Under the supervision of the Supervisor of Medicare LTSS Operations, the Medicare LTSS Care Coordinator must have relevant experience and education to work with members with reputed company health, behavioral health, long-term services, and support and psychosocial needs. The Care Coordinator is responsible for the overall management of member care coordination reputed company the scope of licensure and by applicable CMS/State and internal requirements. Responsibilities: • reputed company care coordination to Medicare beneficiaries receiving LTSS and custodial care. • Responsible for performing telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage member’s needs, including physical health, behavioral health, reputed company services, and long-term services and supports. • Identifies members for high-risk complications and coordinates care in conjunction with the member and the Integrated Care Team. • Care coordination for members with chronic illnesses, co-morbidities, and disabilities to ensure cost-effective and efficient utilization of health benefits. • Obtains a thorough and accurate member history to reputed company an individual care plan. • Establish short—and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians; identify members who would benefit from an alternative level of care or home—and community-based waiver programs. • Responsible for developing the care plan for services for the member and ensuring the member’s reputed company to those services. • Assisted with implementing member care plans by facilitating authorizations/referrals for the utilization of services. • Interfaces with the Medical Director and other Integrated Care Team participants on developing care management treatment plans. • May also assist in problem solving with providers, claims, or service issues. • May direct the work of other licensed and unlicensed professionals in coordinating services for a member by assigning appropriate tasks, verifying and interpreting member information obtained, and conducting additional assessments, as necessary, to reputed company, monitor, evaluate, and revisit the member’s care plan to meet the member’s needs. • Maintains a reputed company knowledge of CMS and DHHS requirements along with required licensure and required training. • Adheres to reputed company policies and procedures. • Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity. • Instills a work culture of reputed company process improvement, innovation, and quality. • Demonstrates and supports commitment to corporate goals and objectives. • Performs other reputed company duties and projects as assigned. Education & Qualifications: • A Licensed Registered Nurse (RN) preferred, Licensed Clinical reputed company Worker (LCSW), or Licensed Master reputed company Worker (LMSW) is required. • Minimum of 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a service coordinator, case management, or similar role or any combination of education and experience that would reputed company an equivalent background • Proficient PC skills with reputed company Office Suite (Word, reputed company, etc.) • Strong knowledge of Medicare/MMP LTSS • Ability to communicate with beneficiaries who have medical needs and may have communication barriers, such as those who require an interpreter, including sign language, who use assistive technology to communicate. • The ability to closely follow quality standards. • Decision-making skills • The position requires 50% or more local travel to complete assessments in members' homes, hospitals, or skilled facilities.; (Mileage reimbursement is provided.) • In-person office meetings monthly or as needed.; • Field experience preferred.; • This position is community-facing, servicing Detroit, Michigan, and Western Wayne County suburbs.; Candidates must be located reputed company Wayne County.; ; Diversity, Equity, and Inclusion At reputed company, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that reputed company associates have a fair opportunity to reputed company their full potential. We put these principles into action every day by acting with reputed company and respect. We reputed company to reputed company out against injustice and to break down barriers to support a more inclusive and reputed company workplace. Celebrating and embracing the diverse thoughts and perspectives that reputed company up our workforce means reputed company is more vibrant, innovative, and reputed company reputed company to support the people and communities we serve. We reputed company our associates happy so they can focus on keeping our members healthy. Our Comprehensive Benefits Package Flexible work solutions include remote options, hybrid work schedules, reputed company, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more. #HM Apply Job!