CHC Service Coordinator, Nursing Facilities – Philadelphia County

UPMC Health Plan is seeking a full-time CHC Service Coordinator, Nursing Facilities to support Community HealthChoices in Philadelphia County!

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 hybrid capacity! This role will support participants across Philadelphia County, and will require significant travel (50% of the time) 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 partners to provide and foster a collaborative environment.
• Educate on and coordinate community resources with emphasis on medical, behavioral, and social services.
• Manage 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 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.
• Ensure comprehensive assessments are completed within required time frames and utilize 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.
• Provide information to members and facilitate access, coordinating and monitoring LTSS needs for members.
• Inform members about available LTSS, required assessments, the Person t-centered service planning process, service alternatives, and service delivery options (including opportunities for self-direction, roles, rights including DHS Fair Hearing rights, risks, and responsibilities).
• Assist with fair hearing requests when needed and requested.
• Collect 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 PCPT in identifying and choosing willing and qualified Providers.
• Work with the member to complete activities necessary to maintain LTSS eligibility.
• Explore 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 coordinate 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.
• Ensure compliance with all state and federal regulations and guidelines in day-to-day activities.
• Maintain confidentiality and adhere to HIPAA requirements.