Oversees the care for long term support services / long term care populations and provides coordination of care services for lower acuity individuals living in the community or nursing facilities. Ensures a comprehensive assessment of member's care needs and status, interdisciplinary team approach, and education of members. Works closely with internal and external partners to achieve optimal health care outcomes for the member through effective coordination of care activities.
REPORTS TO: Supervisor, Field Care Management, PHS-FL LTC
DEPARTMENT: PHS-FL LTC
REPORT TO LOCATION: Sebring, Florida
Coordination and care management of members with lower utilization of home community services (i.e. members attending adult day care services or those who are stable on current medication / treatment regimens).
Manages an active caseload based on state mandated ratios according to residential setting, case intensity and acuity.
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.
Partners effectively with the PCP, Specialist, member, member's family and integrated care teams (ICT) to develop a Person Centered Care Plan.
In partnership with the member, family, physician(s), ICT and other providers, assesses short and long term member needs, evaluates the need for alternative services and establishes member driven care management objectives.
Responsible for coordination of service authorizations (i.e. meals, transportation, activities of daily living).
Educates on and coordinates community resources with emphasis on medical, behavioral and social services. Applies care management standards and maintains HIPAA standards and confidentiality of protected health information.
Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
Performs special projects as assigned.
Required Other For Florida LTC: a Bachelors degree in social work, sociology, psychology, gerontology, or other related social services field
Preferred Other For Florida LTC: a Masters degree in social work, sociology, psychology, gerontology, or other related social services field
Required Other For Florida LTC, must meet one of the following:
Possess a minimum of four (4) years of relevant experience and have a Bachelor's degree in social work, sociology, psychology, gerontology, or a related social services field; or
Possess a master's degree in social work, sociology, psychology, gerontology, or a related social services field may substitute experience obtained through a practicum, internship, or clinical rotation on an equivalent basis for up to two (2) years of the experience requirements;
Non-degreed candidates may substitute professional human service experience on a year-for-year basis for the educational requirement with a minimum of eight (8) years of relevant experience.
If RN, 2 years of experience is required
Intermediate Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Knowledge of healthcare delivery
Intermediate Ability to work as part of a team
Intermediate Ability to work independently
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Demonstrated organizational skills
Intermediate Other Ability to remain calm under pressure
Licenses and Certifications:
A license in one of the following is required:
Required Other CPR Certified
Preferred Certified Case Manager (CCM)
Preferred Other Licensed Behavioral Professional i.e. RN, LPN, LCSW, LMHC, LMFT, LPC, LMST
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Healthcare Management Systems (Generic)
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.