Description
Community HealthChoices (CHC) is Pennsylvania's managed care long term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth, as well as dual-eligible individuals covered by Medicare and Medicaid.
To provide service coordination services across the continuum of care through a community-based approach to improve health outcomes of the Members served. Service coordination's purpose is a for 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.
Responsibilities:
- Actively coordinates 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
- Assist Members in obtaining HCBS services that will support independent living
- Assist the Member and his or her PCPT in identifying and choosing willing and qualified Providers
- Collect s 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
- Explores 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
- 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
- Informing Members about available LTSS, required assessments, the Person t-centered service planning process, service alternatives, service delivery options including opportunities for Self -direction, roles, rights including DHS Fair Hearing rights, risks and responsibilities, and to assist with fair hearing requests when needed and requested, and to protect a Members health, welfare and quality on on-going basis
- Lead the Person-Centered Service Planning (PCSP) process and oversee the implementation of PCSPs
- Providing information to Members and facilitating access, coordinating and monitoring LTSS needs for Members
- Works with the Member to complete activities necessary to maintain LTSS eligibility
Qualifications
- Bachelor's degree in Social Work Psychology or other related fields
- At least three years working in social service or health care related setting
- Completion of person-centered planning and person-centered direction training
- Experience working with people with disabilities or seniors in need of LTSS
- Knowledge of the home and community-based service system and how to access and arrange for services
- Experience conducting LTSS needs assessments and monitoring LTSS delivery
- Cultural competency and the ability to provide informed advocacy
Ability to interact with physicians and other health care professionals in a professional manner is required
Licensure, Certifications, and Clearances:
Driver's License
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities
Total Rewards
More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.
Our Values
At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.