Strategic Engagement Manager overseeing relationships for high - value accounts in healthcare solutions. Developing strategies to drive growth and improve client retention within Zelis.
About the role
- LTSS Service Coordinator handling service coordination for specialized programs. Conducting assessments and developing Person Centered Support Plans while engaging with individuals and their support teams.
Responsibilities
- Responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs
- Facilitates the Person Centered Planning process that documents the member’s preferences, needs and self-identified goals
- Conducts assessments, development of a comprehensive Person Centered Support Plan (PCSP) and backup plan
- Interfaces with Medical Directors and participates in interdisciplinary care rounds to support development of a fully integrated care plan
- Engages the member’s circle of support and overall management of the individual's physical health (PH)/behavioral health (BH)/LTSS needs
- Performs face to face program assessments for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver needs
- Uses tools and pre-defined identification process to identify members with potential clinical health care needs
- Coordinates members’ cases with the clinical healthcare management and interdisciplinary team for care coordination support
- Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities
- Documents short and long-term service and support goals in collaboration with the member’s chosen care team
- 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
- 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 parties such as state and county agencies
- Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits
Requirements
- Requires BA/BS degree and a minimum of 2 years of experience working with a social work agency
- Specific education, years, and type of experience may be required based upon state law and contract requirements
- BA/BS degree field of study in health care related field preferred
- Bilingual in English/Spanish strongly preferred
- LTSS, case management, social work or hospital discharge planning experience preferred
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
- 401(k) + match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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